What Are Copayments for North Carolina Health Plans

A co-payment (or copay) is a fixed-dollar amount that you are responsible for paying for a particular medical service. North Carolina health plans that have this feature are what we typically call a traditional copay plan.  You likely have a copay for primary care visits, specialists visits and prescription drugs.

It is important to understand what is covered by this copay and how they work.  Each carrier works a little differently where some are better than others.  Here's a short list of some of the common North Carolina health insurance companies and how labs and x-rays are covered with their copay for a doctor visit:

• Wellpath:                   Simple labs and xrays covered
• Cigna:                        First $200 for labs and x-rays covered then deductible and coinsurance
• Humana:                    First $200 for labs and x-rays covered then deductible and coinsurance
• United HealthCare:      Labs and x-rays subject to deductible and coinsurance
• Celtic:                        Labs and x-rays subject to deductible and coinsurance
• Aetna:                        Labs and x-rays subject to deductible and coinsurnace

As you can see some carriers give you a lot more coverage than others.  

The other copay that is often used is for prescription drugs.  When researching copay plans you need to pay attention to see if there is an extra deductible for prescription drugs and how this works.  Most carriers plans will cover generic drugs without being subject to the deductible but if you need to get a brand drug filled then you likely are going to be subject to a $200, $500, or even a $1,000 prescription deductible before you will get the drugs covered by the copay.

Hopefully you can see that copays are not all created equal when analyzing your North Carolina health plans options.  Make sure you contact us so that we can explain the pros and cons of these plans to you and assist in finding the right plan for your family.