A copayment (or copay) is a fixed amount that a policyholder pays out-of-pocket for specific healthcare services, prescriptions, or doctor visits under a health insurance plan. It is a form of cost-sharing between the insured and the insurance provider, helping control overall healthcare expenses.
For example, if a health plan has a $30 copay for a doctor visit, the insured must pay $30 at the time of the appointment, while the insurance company covers the remaining cost. Copayments may also apply to prescription drugs, specialist consultations, emergency room visits, and diagnostic tests.
Copay amounts vary based on the type of service and the insurance plan. Typically, visits to primary care doctors have lower copays than specialists or emergency room visits. Preventive services, such as vaccinations and screenings, may be exempt from copayments under some policies.
Unlike deductibles (which require policyholders to pay a certain amount before insurance kicks in), copayments are due at the time of service, regardless of whether the deductible has been met. However, some plans may combine copayments with deductibles and coinsurance.
Understanding copayments helps policyholders anticipate healthcare costs and choose plans that balance premiums and out-of-pocket expenses effectively.
