Copay (Copayment)
Fixed dollar amount paid for doctor visits, prescriptions, or services. $30 specialist visit copay means you pay $30, insurance covers rest.
What You Need to Know
Copay (copayment) is a fixed dollar amount you pay for covered healthcare services. Amount varies by service type and is due at time of service.
Typical copay structure:
- Primary care visit: $20-30
- Specialist visit: $40-60
- Urgent care: $75-100
- Emergency room: $150-300
- Generic prescription: $10-15
- Brand prescription: $40-75
Copays vs coinsurance:
- Copay: Fixed dollar amount ($30)
- Coinsurance: Percentage (20% of $200 bill = $40)
Copays don't count toward deductible but do count toward out-of-pocket maximum. Once you hit OOP max, copays drop to $0 for rest of year.
HDHPs (High-Deductible Health Plans) often have $0 copays until deductible is met—then coinsurance kicks in. PPOs typically have copays that apply even before meeting deductible.
Check if preventive care (annual physical, vaccines) has $0 copay—required by ACA for most plans.
Sources & References
This information is sourced from authoritative government and academic institutions:
- healthcare.gov
https://www.healthcare.gov/glossary/co-payment/
Related Calculators & Tools
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Related Terms in Healthcare
Coinsurance
Percentage of medical costs you pay after meeting deductible. 20% coinsurance on $1,000 bill = you pay $200, insurance pays $800.
FSA (Flexible Spending Account)
A pre-tax account for medical expenses that must be used within the plan year or you lose the money (use-it-or-lose-it rule).
HMO (Health Maintenance Organization)
An HMO offers low-cost health insurance with a focus on preventive care and a network of providers.
In-Network
Doctors and hospitals contracted with your insurance for pre-negotiated rates. Lower costs, higher coverage. Always use in-network when possible.
Medicare
Medicare is a federal health insurance program for those 65+ and certain younger people, crucial for managing healthcare costs.
Medicare Advantage
Medicare Advantage is a private plan that covers Medicare benefits, often with extra perks.