When Texas consumers research health insurance options, the office visit co-pay is one benefit that is typically a priority when determining a plan selection. An office visit co-pay benefit has been considered a requirement for employer sponsored group coverage, which leads consumers to include the benefit when evaluating individual or family coverage outside of the workplace.

An office visit co-pay establishes a fixed, predetermined price for the consultation with a physician. In almost all cases, the office visit co-pay only pays the cost of the consultation. Other services, such as lab, x-ray, injections or supplies are not paid by the office visit co-pay benefit. The predetermined fee ranging in cost from $10 up to $40 depending on the carrier. Health insurance plans can provide the office visit co-pay benefit either with or without a limit in the number of office visits.  

The benefit to the consumer is that the fee for the physician’s consultation is known before service is received. Instead of the office visit charge varying based on the scope of the consultation or specialist, the office visit charge will always be the same.  

The office visit co-pay provides a significantly discounted charge as compared to plans with no office visit co-pay. In Texas, the average consultation with a physician will cost between $125 and $150.

It is important to remember that plans with an office visit co-pay will have higher premiums than similar plans without an office visit co-pay. The cost benefit of the office visit co-pay is realized by comparing the annual cost between the total premium cost and office visit cost of the co-pay plan and the total premium cost and office visit cost of coverage that does not provide the co-pay benefit. If you assume a premium difference between the coverage that includes an office visit with a co-pay is $50 more per month in premium than coverage that provides no office visit co-pay. The $600 annual cost difference of the office visit co-pay plan is divided by the discounted office visit rate of $80 which produces 7.5. The comparison shows that if the policy holder expects to visit the doctor at least 7 times during the year, the higher office visit co-pay premium can be justified from an economic standpoint. However, if the policyholder visits the doctor less than 7 times, the individual spent more on premium than the policyholder received in benefits.

An intangible benefit of the office visit co-pay is the belief that it promotes better health care by reducing the obstacle of cost when seeking treatment. With a predetermined co-pay rate, Texas consumers are more likely to address health issues before those conditions become more serious.

An office visit co-pay benefit are very popular, but it is important to understand their impact on premium cost and on the tangible benefits the provide Texas consumers.


Stateside Insurance Services, since 2003, has focused on providing comprehensive health insurance information, responsive customer service and expert industry knowledge for Texas consumers. Stateside has annually been recognized by health insurance carriers and the Health Insurance Marketplace as a Top Producer in Texas.

Whether the health insurance policy is for an individual, family, small business or supplemental Medicare coverage, Stateside dedicates the time, and our deep industry expertise, to ensure our clients have identified the best health insurance plan for their specific needs. 

Stateside is available to answer any general questions regarding your coverage options, can provide a subsidy determination, and even assist in creating and submitting online applications for ACA compliant plans during an Open Enrollment or throughout Special Enrollment periods. 

Stateside can be contacted either by phone (866) 444-3332 (toll free) or by email at info@texasplans.com. Our Telephone Appointment System can be accessed through:

Phone Appointment Reservation.  
By using the Telephone Appointment System, clients can take advantage of scheduling a health insurance discussion when convenient for their schedule. During Open Enrollment phone appointment availability is expanded to include extended hours and weekends.