Co-payments vs. reimbursement for expat medical insurance

Are you on the hunt for expat medical insurance in Spain but don’t know which to choose? For expats who opt into a private insurance policy in Spain, there are different types of health insurance available which, as a general rule, can be divided into two main groups:

• Medical pool health insurance, with or without co-payments health insurance
• Health insurance reimbursement.

While co-payment for health insurance and reimbursement both entail paying for services rendered at hospitals or clinics, this blog post will explain the major differences between co-payment vs reimbursement that you should consider when taking out an expat medical insurance policy that best suits your needs.

Expat Medical Insurance in Spain: Co-payments vs Reimbursement

The first and most crucial difference stems from the definition of these two types of insurance. Medical insurance with copayment incorporates certain guarantees of services. This means that the client pays a small and typically pre-determined amount in order to access said services. On the other hand, a reimbursement medical insurance policy returns a high percentage of the medical expenses incurred by and covered by the policyholder, as established in the general and specific terms of the individual’s policy.

Is co-payment expat medical insurance right for me?

After you’ve researched various health insurance companies, you may have to decide on co-payments vs reimbursement. What advantages are there to a policy that has copays?

Medical insurance policies that include a co-payment system often have more affordable annual or premiums than those of reimbursement insurance, which, owing to its flexibility, entails a higher annual payment. What’s more, these plans can be better tailored to your (and to your family’s!) healthcare needs.

One of the other major advantages you can expect from co-payment insurance is that there isn’t a fixed limit with regard to the maximum amount of medical expenses you can incur, as stipulated in the terms and conditions of reimbursement medical insurance.

Depending on the insurance plan, different services might have a “one size fits all” cost, or the amount to be rendered can depend on the service. A trip to the ER, in that case, could cost more than a blood analysis; your plan will outline costs for common services as well as unexpected procedures.

Copays are typically charged in the next month’s bill, along with the monthly cost of insurance. Check your policy for specifics.

Are there any drawbacks to the co-payment model?

One of the biggest differences between co-payment and reimbursement concerns the specialists to whom policy holders have access with each type of health insurance: policies with co-payment restrict medical cover to professionals you can go to when the situation is urgent, while with reimbursement medical insurance, you can pick the medical profesional with whom you feel you receive the best care.

Typically speaking, the coverage you’d receive in a reimbursement model would include a more robust menúu of options, from ER visits and unforeseen necessities to routine checkups or even telehealth. Your plan will likely cover up to 80% or even 90% of your medical costs, until you reach a certain annual amount. In order to receive reimbursement, you must folllow your insurance company’s guidelines for making claims, which Will probably be via an online portal in which you would upload a receipt of the services rendered.

Also note that reimbursement plans may have a deductible, which is the amount that the policy holder must pay before the insurance company begins to reimburse expenses.

If you’re an avid traveler, you may want to think twice before taking out a copayment plan. Medical coverage with co-payments often restricts access to domestic specialists in the country where you have taken out a plan; however, reimbursement medical insurance grants you access to specialists worldwide, in accordance with the conditions of the specific policy which is taken out. Simply follow the insurer’s steps to making a claim after you have received and paid for treatment.

What is the cost difference between these two payment schemes?

Medical insurance with co-pays is often the sort of plan recommended for young, healthy people who want the security of private health insurance but do not plan to use their coverage regularly – and it tends to be more economically favorable in the long run and monthly premiums stay consistent. What's more, insurance companies tend to cap what you will pay in copays, In Caser's case, this amount is limited to 395 euros annually, after which the company will assume the cost of any additional services.

Reimbursement policies are more comprehensive in nature, though you will have to ensure that you have the money necessary to cover the services upfront and it'll ultimately pay more annually. 

Your policy - regardless of if you choose co-payment vs reimbursement - will often include that a reimbursement for costs incurred at pharmacies, at an optician's office or even for childhood vaccines included on an official vaccination calendar, up to a certain amount annually per insured party. 

What plan should I consider for expat medical insurance?

Start by calculating the basal cost of your health insurance plan by using a cost calculator that takes into account your age, where you will be living and any additional health factors, as well as coverages you’d like to explore.

Caser’s expat medical insurance coverage options range from individual expats to families who have made the move, and they can be tailored according to your needs – and, yes, that also means you can choose if you want a co-payment or a reimbursement plan.

The Prestigio health insurance reimbursement plan is practically comprehensive, as you will receive up to 90% of your worldwide medical expenses back – plus, you won’t have any co-payments! If you choose the Inicia co-payment insurance plan, you’ll be able to take advantage of co-payment insurance when you need it and without paying a higher premium for services you may never use.

Apart from a medical portfolio of top professionals and round-the-clock care, you can also expect help and guidance in your language, telehealth options and a wide range of service available for you.

When choosing between co-payments and reimbursement, you should consider factors such as your preferences in care and coverage, your current financial situation, and the convenience of the payment process – this is especially true if you plan to travel extensively abroad or even head back home for short stays. While some may prefer the predictability of co-payments, others might be comfortable with reimbursement procedures, understanding that they need to have sufficient funds to cover any costs that are incurred upfront.

No matter what you choose, it's essential to carefully review the terms and conditions of the expat medical insurance plan to understand how costs are shared between the insured and the insurance provider.