Understanding Co-Payments
SPECIAL REPORT: Understanding Co-Payments – What You Still Owe
Intro: “My Plan Covers 80%”… But Who Pays the Other 20%?
It’s the question almost no one asks — until they see their credit card statement:
“Why did I still owe $25 after my insurance covered it?”
Welcome to the world of co-payments (or co-insurance), a quiet but crucial part of your healthcare plan.
Understanding what co-pays are — and how they work — can help you plan better, avoid surprise charges, and use your benefits smarter.
Let’s break it down.
💳 What Is a Co-Payment (or Co-Insurance)?
A co-payment is the portion of the treatment cost that your insurance doesn’t cover — meaning, you pay it out of pocket.
It’s usually expressed as a percentage of the total cost.
| If your plan covers… | You owe… |
| 100% | $0 |
| 90% | 10% |
| 80% (most common) | 20% |
| 50% (low coverage) | 50% |
So if your massage costs $100 and your plan covers 80%, you’ll pay $20 out of pocket.
This amount is not reimbursed later — it’s your share to pay at the time of service.
🏥 Why Do Co-Payments Exist?
Insurers use co-pays to:
- Encourage responsible use of services
- Reduce over-claiming or unnecessary visits
- Share the cost between you and your employer
It also helps keep premiums lower by not covering everything fully.💡 Tip: Some high-end plans (executive packages, union-negotiated plans) may offer 90–100% coverage with no co-pay.
🧾 How to Know What You’ll Owe Before Your Visit
Your benefits booklet (or insurer portal) will state your co-insurance percentage for each service:
- Massage Therapy: 80%
- Physiotherapy: 100%
- Chiropractic: 90%
Also look for:
- Per visit caps (e.g. “up to $60/session” regardless of actual cost)
- Annual limits (e.g. $500/year)
💬 Not sure how much you’ll owe? Ask Ruby to calculate it at insurance.rmtclinic.net
⚠️ Hidden Costs to Watch For
Even with coverage, you might still owe more than expected if:
- Your clinic charges more than the insurer allows
- Your therapist is out-of-network or not RMT-certified
- You’ve used most of your annual limit
- You misunderstood your co-insurance amount (e.g. thought it was 100%)
✅ RMTClinic.net only lists verified RMTs with transparent pricing and insurance-ready receipts.
🧠 The Difference Between Co-Payments and Deductibles
| Term | What It Means |
| Co-Payment | % you pay per visit (e.g. 20% of each massage) |
| Deductible | $ you must pay each year before coverage starts (rare for paramedical) |
Most Canadian plans don’t require deductibles for RMT, chiro, or physio. But co-payments are common.
✅ Action Plan: Ask Before You Book
Always ask your clinic:
- “What’s your rate for a 60-minute session?”
- “My plan covers 80% — so what will I owe at the end?”
- “Do you submit direct billing, or do I pay upfront?”
🧭 How to Maximize Coverage with Smart Co-Pay Strategy
- 📆 Book longer sessions less frequently to reduce repeated co-pays
- 👨👩👧 Use spouse’s plan second to cover remaining % through Coordination of Benefits
- 🧾 Track every visit and receipt to ensure full reimbursement
💬 Ruby can help check how much you’ve claimed YTD and what’s still available.
✅ Action Checklist
- 📖 Review your benefits booklet co-insurance %
- 🧮 Use our calculator at insurance.rmtclinic.net
- 🔍 Search clinics that minimize co-payments at RMTClinic.net
- 🧾 Keep receipts for tax + coordination use
✍️ About the Author
Henry Tse is the founder of RMT Clinic Network Organization. Through clear education and empowering content, he helps Canadians navigate the fine print of insurance plans to make every dollar count — with less stress and more care.
