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What You Need to Know: Co-insurance & Co-pay

This article is part of a series on what you should look for in your health plan.

GDA_20160629_Biddy-01-EditAt medical plan renewal time, the Georgia Dental Association office is always flooded with calls from members asking about how to choose a health plan that is right for them. While premium cost is always of concern, more and more dentists, spouses, and staff members want to share their medical insurance horror stories and ask if their dental association can help them find a better option. That is my favorite part—when I and the rest of the GDA health plan team can talk to members about the competitive, comprehensive health plans the GDA has for dentists, dental families, and dental team members.

Since we are about to enter the medical plan renewal season once again, your GDA health plan team wants to share some basic tips about choosing a health plan. We also want to share that you can choose a GDA group health plan starting November 1! We are excited about the options we will be able to offer our members. Call your GDA health plan team at 800.432.4357 for information, or visit us online at to see our complete plan information and sign up for a webinar on November 4.

Health Insurance In the News

“Most hurt will be marketplace consumers in Arizona, North and South Carolina, Georgia and parts of Florida, where only one or two insurers will be left when open enrollment season begins Nov. 1.”

--National Public Radio, 8/8/16

What You Need to Know: Co-Insurance & Co-Pay

You may see the term co-insurance quite a bit. This is different from a co-pay. A co-pay is a set amount you pay whenever you use a particular kind of health care service. For example, you might have a set $30 co-pay each time you see a primary care physician. Co-insurance is the percentage of costs of a covered health care service you owe (30%, for example) after you've paid your deductible.

Let’s say your health insurance plan’s allowed amount for an outpatient procedure is $1,000 and your co-insurance is 20%. If you've paid your deductible, you pay 20% of $1,000, or $200. The insurance company pays the rest. If you haven't met your deductible, you pay the full allowed amount of $1,000. Co-pay amounts will typically remain standard through the course of a plan year. Every time you visit your primary doctor, you will pay that set amount. While your co-insurance percentage will remain the same, for example, 20%, the dollar amount you pay will vary depending on the percentage of a particular service or procedure.

We work for you.

Christy Biddy is your Medical Benefits Coordinator, and can be reached at or 404.636.7553 x113.

Open Enrollment 2016 Health Plans