To answer this, let’s look at what a Dr. Office copay actually is: a flat rate that pays for an office visit and some treatment performed inside the doctor’s office. This often does not apply to lab work or x-rays. As always you’ll want to refer to your policy for clarification.
Ask yourself: “How many visits did I/we make to the doctor in the last 3 years that were NOT related to wellness or check-ups?”
If the answer is 1-2 per person, per year you are probably better off without one. This benefit costs extra premium to include in your plan. If your carrier breaks down the cost of this benefit you can do a little math to determine its value to your family. As an example we’ll use a husband and a wife.
| $35 Dr. Office Copay benefit | ||
|---|---|---|
| Cost of Dr. Office Copay in monthly premium | $80/mo | $960/yr |
| Cost of Dr Visit (without a copay benefit) | $80 (full rate) | $56 (after network discount) |
Let’s assume that both the husband and wife visit an in-network doctor two times that year.
| Number of Dr. Visits | Cost Per Visit | Annual Total for Visits | Annual cost of Copay | Savings |
|---|---|---|---|---|
| 4 | $56 | $224 | $960 + cost of 4 visits ($140) = $1,100 | $876 |
Also worth noting:
- The $224 spent for the office visit is applied toward your plan deductible. The cost of a copay ($35) does not.
- The cost of an office visit WITHOUT a copay, after network discounts is often close to the copay amount.
- Wellness visits and immunizations are covered without any out of pocket as per the Healthcare Reform Bill.
