How do tiered copays work?

Who is this for?

Michigan Health Insurance – Customer Service – Learn More

You’ll need this information if your Blue Cross Blue Shield of Michigan plan offers 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 a few 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.

What primary care physicians and practitioners are in the lowest tier of copays?

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 be in 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 your plan has tiered copays.