Copay Trap

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Diane Pickles had comprehensive health insurance when her son Jake was born with heart damage, but the medical bills still added up quickly, stretching the Haverhill family's budget.

Each visit to a doctor cost her family $20 or $25. And after Jake developed asthma, there were frequent copayments for medicine and charges of $50 each for trips to the emergency room. Some months, these bills totaled more than $500, she said.


The copay trap. Something most people fail to account for when looking at health insurance.

One provision would limit out-of-pocket expenses to $5,000 for an individual and $10,000 for a family. But insurers are not required to count copayments of $100 or less, or amounts paid for prescription drugs, or payments for services outside the health plan's network of doctors.

"Out-of-pocket limits should include all out-of-pocket costs,"

Why?

I have never seen a plan that includes copays as part of the out of pocket limit. If carriers did offer such a provision it would only increase the premiums for everyone.

Guess Diane didn't consider that.