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What's the difference? Copays vs. Coinsurance‍

Your health insurance shouldn't have to be confusing.

Have you ever received a bill from the hospital or your health insurance company that you never even expected? Was the cost so much that you can’t even fathom paying for it? Healthcare consumers like you deserve to know how much your health care services cost so that you don’t get surprise bills like this. Keep reading to find out how Taro Health believes in zero to low costs on health care that you can actually use like primary care or mental health visits. 

Taro Health’s direct primary care physicians have shared their patients’ concerns about surprise bills. Taro Health has decided to make a change by working with direct primary care physicians who care about affordability and costs that get passed onto the patients.  Taro Health and our network direct primary care physicians don’t want to make it any more confusing for you as a member. We’ve found that members will not proactively engage with their health because they can’t understand how much they’re going to pay. Taro Health wants to clear up some of that confusion here: 

What’s a copay?

  • Also known as a copayment. A fixed dollar amount you pay for a covered service, usually when you receive the service. The amount can vary depending on the type of service. (For example, $25 to visit your doctor, $10 for prescription drugs). Once you reach your out-of-pocket limit, you no longer have copays for the rest of the plan year.

Taro Health plans have fixed copays so that you as a member will always know what you’re paying out of pocket. There are $0 copays for many health care services that you will actually use–like going to your direct primary care physician for strep throat or to get your blood work done. Here is a full list of Taro Health’s plans where you can find your cost share for various services. 

What’s coinsurance? 

  • A coinsurance is your share of the costs for covered services that you pay when you receive them. Coinsurance is calculated as a percent of the total fee. For example, if your health insurance plan charges you a 20% coinsurance, when you see a doctor and the total visit is $100, your patient cost share is 20% of $100, which would be $20. 
  • Some plans require that you pay up to the plan's deductible amount before coinsurance begins. You’d be paying 100% of the fees until your deductible is reached – when your deductible is $4500, you’ll be paying everything out of pocket up until $4500 until your coinsurance starts and only then will you be paying a percentage of the total fee.

Taro Health does not have any coinsurance in any Bronze or Silver Direct Primary Care Taro Health plans available. Review the full list of Taro Health’s plans.

Copayments make it much easier for you as a patient and a Taro Health member to understand your upfront costs. Although some plans may include coinsurances, Taro Health plans cover most commonly used health care services at $0 copay amounts. Join a Taro Health plan this fall by signing up directly on our website or heading to coverme.gov.

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Our plans will be available for purchase starting on November 1, 2022. Sign up below to be the first to join!
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