Copay
A fixed dollar amount you pay for a specific healthcare service, like $25 for a doctor visit, regardless of the total bill.
Last reviewed August 23, 2026
Definition
A copay (or copayment) is a fixed dollar amount you pay for a specific healthcare service at the time of the visit. Common copay amounts are $20–$50 for primary care visits, $40–$80 for specialist visits, and $10–$50 for prescriptions.
Copays are predictable. You know exactly what you'll pay before the appointment. They're separate from your deductible and may or may not count toward it depending on your plan.
Common copay types:
- Primary care visit: $20–$40
- Specialist visit: $40–$80
- Urgent care: $50–$100
- Emergency room: $150–$350
- Generic prescriptions: $5–$15
- Brand-name prescriptions: $30–$100+
- Mental health visit: $20–$60
Some services are covered with no copay (preventive care on ACA-compliant plans). Some plans waive copays after you meet your deductible. Check your Summary of Benefits for your specific plan.
Copays appear on your Explanation of Benefits as part of your share. How to read an EOB covers how they sit alongside the deductible and coinsurance.
Examples
You visit your primary care doctor. Your plan has a $30 copay for primary care. You hand over $30 at the front desk, regardless of how much the visit actually costs.
Your plan has a $250 copay for emergency room visits after meeting your deductible. Before meeting it, you pay your deductible first, then the copay kicks in.
Your plan charges a $15 copay for generic drugs and $45 for preferred brand-name drugs. Asking your doctor for the generic equivalent saves you $30 per refill.
Frequently asked questions
Do copays count toward my deductible?
It depends on your plan. Some plans count copays toward the deductible; others keep them separate. Check your Summary of Benefits and Coverage (SBC) to see your plan's rules.
Do I still pay a copay after I meet my deductible?
Usually yes. Copays typically continue after your deductible is met. However, once you reach your out-of-pocket maximum, copays stop and insurance covers 100% of covered services.
What's the difference between a copay and coinsurance?
A copay is a fixed dollar amount ($30). Coinsurance is a percentage of the total cost (20% of a $500 bill = $100). Copays are predictable; coinsurance varies with the cost of the service.
Related terms
Deductible
The amount you pay out of pocket for covered services before your insurance begins to pay.
Premium
The recurring payment you make, monthly, quarterly, or annually, to maintain an insurance policy.
Out-of-pocket maximum
The most you'll ever pay in a plan year for covered services, after which your insurance pays 100%.
Coinsurance
The percentage of costs you share with your insurer after meeting your deductible, for example, you pay 20%, your insurer pays 80%.
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