Copay
A fixed dollar amount you pay for a specific healthcare service — like $25 for a doctor visit — regardless of the total bill.
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.
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.
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