How do tiered copays work?

When you’re paying for health insurance, it’s nice to know you’re getting your money’s worth. That’s especially true when it comes to copays. Luckily, some of our plans now offer a feature that allows you to get many kinds of care at a lower cost. We call this feature a “tiered copay.”

What are tiered copays?

Not all health care services are created equal. A routine visit to your family doctor’s office is much different than a trip to a specialist, so it makes sense that they wouldn’t cost the same. Our plans with tiered copays connect the amount you pay to the type of care you receive.

What does this mean for me?

If your plan offers tiered copays, you’ll find one of three kinds of payments when you pay for your health care. The lowest copays will be for office visits to a primary care physician, physician’s assistant or nurse practitioner. If you need to visit urgent care or see a specialist like a cardiologist or an immunologist, your copay will be a little higher.  The most expensive copays will come when you visit the emergency room.

Tiered copays can save you money, because some specialties are covered by primary care doctors and practitioners. For example, office visits for gynecological exams and spinal manipulation can cost about the same as a visit to your family doctor. That means you can still get a low copay, even when you’re receiving specialty care.

What primary care physicians and practitioners cost less?

There are many doctors and practitioners with a primary care specialty. An office visit to any of the following kinds of health care professionals will save you money because they are eligible for the lowest tier of copays:

Family practice

• Adolescent medicine
  
• Family practice
  
• Geriatric medicine – Family practice

General practice

• Family nurse practitioner
  
• Preventive medicine

General practice

• Adolescent medicine
  
• Family practice
  
• General practice
  
• Public health / General preventive medicine
  
• Preventive medicine

Geriatric medicine

• Geriatric medicine – Family practice
  
• Geriatric medicine – Internal medicine

Internal medicine

• Adolescent medicine
  
• Geriatric medicine – Internal medicine
• Internal medicine
• Internal medicine – Pediatrics

Obstetrics and gynecology

• Obstetrics and gynecology
  
• OB/GYN nurse practitioner

Pediatrics

• Adolescent medicine
• Pediatrics
  
• Pediatric nurse practitioner

Nurse practitioner

• Certified nurse practitioner
  
• Family nurse practitioner
  
• OB/GYN nurse practitioner
  
• Pediatric nurse practitioner

Physician assistant

• All provider specialties

Tiered copays are not available for all Blue Cross Blue Shield of Michigan health plans. Check your plan riders or call the phone number on the back of your member ID card to find out if you’re eligible.

Related items

• What do I need to know about primary care physicians and specialists?
• How do I find a doctor?
  
• What's a copay?