Copay

What is a copay?

Under health insurance policies, copay refers to the portion of a bill that the insured person pays, usually at the time of service. Often, it is expressed as a set fee for a specific service.

Deeper definition

A copay, short for “co-payment,” is a fixed amount that you pay for medical services at doctors’ offices and hospitals. The amount is due in full at the time of service.

Copay is a set amount rather than a deductible or percentage of the health bill, which makes it easy to budget for health appointments (except emergency care).

Knowing your copay amounts before choosing one health insurance plan over another may be an important factor when considering your health insurance costs.

Copay amounts typically vary from service to service and can apply to one or more of the following health care services:

• Doctor’s appointments.
• Urgent care center visits.
• Emergency room visits.
• Prescription medications.

Copays for regular doctor visits are often $25 or more. Emergency services, such as an urgent care or emergency room visit, can cost hundreds of dollars, though the exact amounts can vary significantly, depending on your health insurance plan.

Finally, not all insurance companies offer copays for regular appointments or hospital visits, and instead they bill by percentage of the total cost after the time of service. For these health insurance plans, no payment is remitted at the time of service, and members are sent a bill from the doctor or hospital after the insurance pays a portion of the fee.

Copay example

A regular checkup for your child generates a $20 copay, which is due at the time of service. Your plan may not have a copay amount for basic services, but may include one for emergency and prescription services. If you were to break your wrist, your emergency room visit might incur a copay of $150, and your prescription for pain medication might have a copay of $10. These copays would be remitted to the hospital and pharmacy, respectively, at the time of service.