How to Budget for Medical Copays


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Have you ever skipped filling a prescription after a trip to the doctor because of the cost? According to a study done by the Centers for Disease Control and Prevention (CDC), 11% of adults in the U.S. avoid taking their prescribed medications to save money.

With the typical copay for a primary care physician ranging from $15 to $25 and a visit to a specialist ranging from $30 to $50, the costs of routine doctor visits and filling necessary prescriptions add up.

Throw in trips to an urgent care or emergency room visits, which can cost hundreds of dollars a pop, and it’s enough to make you consider suffering through whatever’s ailing you.

But not taking medications or skipping a trip to the doctor or ER is not a good money-saving strategy. In fact, that tactic can cost you more in the long run and can have serious implications. A better approach is to plan for the expenses.

How Much Do You Spend on Copays?

Many factors affect your actual spending on doctor visits and medications such as the terms of your specific insurance plan, family size, where you live, your health status, the frequency of doctor visits and filling prescriptions, and even your income level.

But, on average, health care costs account for just over 8% of the average American household's total spending, according to the U.S. Bureau of Labor Statistics.

Of the total annual health care spending, which includes insurance, roughly 18% is spent on "medical services"—encompassing doctor and dentist copays; almost 10% goes towards prescription drugs; and over 3% is spent on "supplies"—including eyeglasses, contacts, and medical equipment.

Tips to Prepare for Copays

Outside of your annual physical or other routine visits, it’s difficult to predict precisely when you’ll have to shell out money for your next medical or prescription copay. But there are strategies you can employ to help you be prepared for the expense—whenever it comes.

Take Advantage of an FSA

Setting aside a portion of your pre-tax income for medical expenses in a Flexible Spending Account (FSA) through your employer, if available, is a great way to save money and stretch your health care budget. Just be sure not to overestimate how much you’ll use, or else you’ll lose money at the end of the year.

Establish a Copay Fund

If you do not have access to an FSA or you anticipate your spending will exceed the contribution limits, decide to set aside money in your budget each month for doctor and dentist visits and prescriptions, regardless of whether or not you anticipate an expense that month.

For an accurate idea of your actual spending, look back on the past 12 months of your explanation of benefits statements, and calculate how much to set aside each month. Essentially, you’re establishing savings ahead of time so that you have the funds available when needed. You may want to consider keeping the fund in a separate account with its own debit card to make sure the money isn’t spent elsewhere.

Reduce Your Spending on Medications

Again, skipping out on filling prescriptions isn’t the best savings strategy. Instead, actively seek ways to spend less on your meditations. For example, filling them through your insurance company’s mail-order program may be cheaper than going through your local pharmacy.

Likewise, ask your pharmacist to compare the costs of filling your prescriptions with and without insurance. In some cases, it may be cheaper to pay out-of-pocket because established copays for prescriptions can sometimes be higher than the actual cost of the medication. According to a recent study, 23% of prescriptions were overpaid for because the consumer was not aware of the higher cost of the copay.

Prioritize Your Health

While the cost of visiting the doctor and filling prescriptions is high and presents a valid struggle, keeping yourself and your family healthy should be a priority.

Plan ahead as much as possible so that handling the costs of your copays is merely an expense and not a budget buster.

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The Balance uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. "Strategies Used by Adults Aged 18–64 to Reduce Their Prescription Drug Costs, 2017."

  2. U.S. Bureau of Labor Statistics. "How Have Healthcare Expenditures Changed? Evidence From the Consumer Expenditure Surveys."

  3. Karen Van Nuys, Geoffrey Joyce, and Rocio Ribero. "Frequency and Magnitude of Co-payments Exceeding Prescription Drug Costs," Journal of American Medicine.

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