How much is the co-payment per visit?

It depends on the insurer and the service. GP visits usually have small co-payments, and some tests or services slightly higher ones. Before you sign, ask to see the policy’s co-payment table.

Is there a yearly cap on co-payments?

Some insurers set a yearly cap on co-payments per insured person and others don’t. It’s an important detail if you’ll use the policy a lot.

Can I switch from co-payment to no co-payment later?

Usually yes, at renewal. Each insurer has its own conditions, and sometimes the switch means reviewing the health questionnaire.

Which option is better for children?

Young children see the paediatrician a lot, so no co-payment, or very low co-payments, usually works out better.

Health insurance with or without co-payment (copago): how to choose

Short answer: if you only see a doctor a few times a year, a policy with co-payment (con copago) is usually cheaper. If you use it often, have young children or ongoing treatment, a policy without co-payment (sin copago) tends to work out better. But the real difference depends on how much each co-payment costs on your policy, so it’s worth doing the maths with real numbers. Here’s how.

What co-payment is

Co-payment (copago) is a small amount you pay each time you use the policy: a consultation, a test, a physiotherapy session. It comes on top of the monthly premium.

In return, the premium for a policy with co-payment is lower than for an equivalent one without. In other words, you pay less each month and a bit more each time you see a doctor.

Without co-payment: higher premium, nothing extra to pay when you use it.
With co-payment: lower premium, a small payment for each use.

Neither option is better across the board. The better one is whichever fits how much you use the policy.

The maths you need to do

Take two equivalent policies, one with co-payment and one without, and work out:

The yearly premium difference: how much more you pay per year for the no co-payment option.
The co-payments you’d pay in a normal year: how many consultations, tests or sessions you have a year, multiplied by the co-payment for each.

If the co-payments in point 2 are lower than the premium difference in point 1, go with co-payment. If they’re higher, go without co-payment.

Rough example: if the no co-payment option costs you quite a bit more per year than the co-payment one and you only see a doctor three or four times, co-payment will almost certainly pay off. A family with two children who see the paediatrician every month will probably save with the no co-payment option.

I’ll prepare this comparison for you using the real tables from several insurers, so you don’t have to guess.

When each one usually makes sense

With co-payment, if:

You’re young and rarely see a doctor.
You want the policy mainly for peace of mind: specialists, emergencies or a possible operation.
You want the lowest possible monthly premium.

Without co-payment, if:

You have young children.
You have a chronic condition or treatment that needs frequent visits.
You use physiotherapy, psychology or other services regularly.
You’d rather know exactly what you pay each month, with no surprises.

Details many people don’t check

The co-payment table. Not all co-payments are the same: some services (emergencies, complex tests, psychology) can have different amounts. Ask for the full table.
The yearly cap. Some insurers limit how much you can pay in co-payments per year. If there is one, it’s an important protection.
Services without co-payment inside co-payment policies. Sometimes hospital stays or certain tests have no co-payment, even if the policy charges one for consultations.
The network (cuadro médico). A cheap premium is no use if the doctors you want aren’t near your home.
How the premium changes with age. Premiums are usually reviewed every year. Ask how they’ve changed at that insurer in recent years.

And waiting periods

With or without co-payment, some cover has a waiting period (carencia): the time that has to pass after you sign before you can use it (for example, childbirth or certain procedures). If you have something specific in mind, tell me before you sign so we choose the right policy.

In short

Low use → with co-payment, lower premium.
Frequent use, children or ongoing treatment → without co-payment, no surprises.
Do the maths with the real co-payment table and the premium difference, and check yearly caps, the network and waiting periods.

I’m an insurance advisor in Valencia and I work in English and Spanish. Tell me who needs cover and how often you tend to see a doctor, and I’ll prepare a side-by-side comparison of both options.