Close Menu
    Insurance

    Why the fuck do we pay Copays and deductibles in the US

    I really do not understand and if somebody who works in Health Insurance in the US can explain, why the hell do we pay Copays.

    If they are gonna cover a $10,000 medication or procedure why won't they cover the last $60??

    Why the fuck do we pay Copays and deductibles in the US
    byu/throw-away-2025rev2 inInsurance



    Posted by throw-away-2025rev2

    View 28 Comments

    28 Comments

    3. jenbellun on

      To discourage fraud, waste and abuse and introduce skin in the game. Same goes for a $50 ER copay. If it’s $0, everyone would run to the ER. On drugs, almost always there is a cheaper alternative, putting in a cost share helps steer to the most cost effective treatment

    4. MangoSorbet695 on

      Moral Hazard

      People make different decisions when they know they will bear zero cost of those decisions.

    6. buffalo_0220 on

      It’s a way for the insured to have skin in the game. It’s also a way to influence behavior, you are more likely to go to your regular doctor or urgent if the co-pay is $20, than the ER where the co-pay is $50 or $100.

    8. Big_Celery8533 on

      It’s about control. Copays are meant to discourage overuse of care that your insurance provider doesn’t want you to access, at least not without some awareness of how much it costs. They they cost money to administer and cause billing errors, but the point of copays is ultimately to cause enough friction so that you delay or skip care or medication, saving the insurer money.

    9. cormack_gv on

      To discourage you from using services. In Saskatchewan in the 1960s before they were banned, they were called “deterrent fees.”

    10. InvisibleBlueRobot on

      It discourages you from using the service and lowers their cost by making you pay this. 

       The system is designed around profits for them, not for good, affordable healthcare for you. 

    15. BlueOceanGal on

      Because the insurance company runs our lives, at least they do mine. And they’re allowed to by people who don’t have to jump through the hoops we do. Not only do we have to pay co-pays…

      We start off paying premiums for the healthcare plan with specific benefits that we choose from among whatever choices we are given, either from our place of employment or the marketplace.

      Those premiums come out of every one of my paychecks. Then every time I see a doctor there’s a copay. If I have a surgery, there’s also money that goes towards a deductible and an out-of-pocket max and if you spend enough, you’ll get into where coinsurance is a factor, as well. All calculated numbers based on the plan we chose.

      I have to call mine because currently they show that I owe more than my out-of-pocket max for the year and that’s not right. And if you do happen to meet your out of pocket max for the year, it starts all over again the next time. How about a lifetime max? Because I would have hit that by now. Trust me on that.

      In my view, it’s nothing more than a scam so that insurance companies can make profit off of our illnesses. It’s a middle man money maker. In no world is this right and 32 other countries have managed to have Universal Health Care but not the USA. It is a massive scam based on nothing more than greed and predatory commerce. I will never agree with this broken system. 🤬🤬🤬🤬

      And if you are sick with an ongoing illness or have health issues, you will be paying and paying and paying and paying and paying and paying and paying until the day you die. And by the way, in no other country have so many people filed bankruptcy because of medical bills. One serious illness in the US like cancer or autoimmune will wipe out every penny you have to your name, ONE. “Studies estimate that approximately 500,000 to 650,000 people in the United States file for bankruptcy each year due to medical bills.” Every year! Google it.

    16. erisod on

      It’s to deter usage of the insurance .. if you really need it you will pay the cost but it will be within reach. If it’s borderline needed then you might decide not to do it

    18. Ars139 on

      Because if you don’t pay at all behaving like it’s owed to the patient you don’t appreciate it.

    19. JP2205 on

      Deductibles are much worse. So we go to the doctor sometimes but insurance never pays a dime. Until we pay like $2500 per person they don’t pay anything.

    20. WildFlowLing on

      Because people would actually go to the doctor if it was free. $20 copay will prevent a lot of people from going. Then the insurance company makes 100% profit on you.

    22. Alternative_Sock_608 on

      There used to be just copays, and now there is also “coinsurance” which seems to be another word for “a way to make the consumer pay more”

    23. trantor-to-tantegel on

      So I’m probably wrong, but aren’t those paid from the “first $X”, not the “last”? I always figured it was a way to defray more minor costs on the part of the insurance industry – “Oh, you need some attention, but only like $400 of attention? Well, that comes out of your pocket. We’ll cover the next chunk.” That kind of thing?

      I’m also deeply ignorant/intimidated/angry with insurance in general, so I could totally be wrong. It feels like it’s the only single product that not only is designed to be complicated and confusing, but that is allowed (and encouraged?) to be complicated and confusing. So I always have trouble engaging with it.

    24. Mountain-Arm6558951 on

      It really started back in the 1970’s and 80s… Major medical always had a deductibles for hospitalization and copays office visits. Back then they did not cover everything under the sun like prescriptions or lab work. Healthcare started to run away in the 80’s and you saw birth of the PPOs and copays for everything. By the late 80s to early 90s everyone wanted insurance to cover meds, lab work and imaging.

      Also it was common in that time only to have coverage for hospitalization as employers only offered it. Carriers like Blue Cross (hospital) and Blue Shield (physician) started as separate entities and merged over time, with the national associations merging in 1982.

    25. Suitable-Bluejay9493 on

      Health Insurance is like the casino, they always win. We are just forced to be suckers that play their game. 

    Leave A Reply
    Share via