Copay vs coinsurance: What is the difference?

Dental insurance plans can help cover the costs of cleanings, exams and dental procedures. But for some services, you may be asked to pay an out-of-pocket cost called a copay or coinsurance.

Here’s a look at what these terms mean, how they’re different and more.

What is a copay?

A copay, short for copayment, is the amount you pay out-of-pocket for a dental service. Copays are usually a set price and the amount can depend on your plan and the service you receive. For example, you may have a $20 copay each time you get a cleaning, and a $40 copay to get services like a dental crown.

You pay the copay directly to your dentist at the time of service.

What is coinsurance?

Coinsurance is the percentage of costs you pay for dental services after you've met your deductible. For example, if you’ve met your deductible, your dental plan might pay 70% of the cost for a dental filling. The coinsurance you pay is the remaining 30%.

Your dentist will typically send you a bill for your coinsurance days or weeks after your visit.

Here are some common differences of copays and coinsurance to consider:

What are out-of-pocket maximums?

An out-of-pocket maximum is the most you’ll pay for in-network dental services in a plan year. Once you reach your out-of-pocket maximum, your dental plan will pay 100% of the costs for in-network covered services. For example, if your out-of-pocket maximum is $3,000, you only pay up to $3,000 for that year. Every dollar charged after that for in-network covered dental expense will be paid by your dental plan. And, since copays and coinsurance are both out-of-pocket costs, they both count toward your out-of-pocket maximum.

Learn about dental plans with Humana

At Humana, you can choose from a variety of plans to find the best copays and coinsurance for your needs. To explore plans and prices in your area, check out our individual and family dental insurance plans.