Copayment
A copayment is a fixed amount you pay for a covered healthcare service, often at the time of service, after you have met your deductible or as part of your plan's cost-sharing structure.
What is a Copayment?
A copayment is a fixed amount you pay for a covered health care service after you've paid your deductible. For example, if your health insurance plan's allowable cost for a doctor's office visit is $100 and your copayment for a doctor visit is $20, you would pay $20. It's common to have separate copay rates for different types of care, such as a different copay for a primary care doctor visit versus a specialist visit, or even for prescriptions.
Copayments are typically paid at the time of service, for example, at the pharmacy or doctor's office. In some cases, for high-deductible plans with health-savings accounts (HSAs), IRS rules require the plan deductible to be satisfied before any copay or coinsurance is applied. Copayments usually count toward your deductible in some cases.
What is the difference between a Copayment and Coinsurance?
Both copayments and coinsurance are out-of-pocket expenses for healthcare services. A copay is a fixed fee paid at the time of service, while coinsurance is a percentage of the total cost paid after the deductible is met. Copays can apply before or after the deductible, while coinsurance only applies after.
Copay: A fixed amount paid for services. Coinsurance: A percentage of the total cost.
Copay: Can apply before and after you reach your deductible. Coinsurance: Applies only after you reach your deductible.
Copay: Paid at the time of service. Coinsurance: Usually paid after the time of service.
What are examples of a Copayment?
You visit your primary care doctor for a check-up. Your health insurance plan has a $20 copayment for primary care visits. You pay $20 at the time of your appointment.
You need a prescription filled at the pharmacy. Your plan has a $10 copayment for generic drugs. You pay $10 when you pick up your medication.
You see a specialist for a skin condition. Your plan has a $40 copayment for specialist visits. You pay $40 at the time of your appointment, after your deductible has been met.
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