A copay is a fixed dollar amount you pay for a specific health care service at the time of your visit. Your insurance covers the rest. Copay amounts are set by your plan and vary by service type.
Common copay examples:
Copays may apply before or after your deductible depending on the service and your plan. Many plans cover primary care and prescriptions with a copay even before you’ve met your deductible — but confirm this in your plan’s Summary of Benefits and Coverage.
Copays count toward your out-of-pocket maximum. Once you hit that limit, you typically pay $0 for covered services for the rest of the year.
No. A copay is a flat dollar amount (e.g., $30 per visit). Coinsurance is a percentage of the cost (e.g., you pay 20% of a $500 bill). Some plans use one, some use both, and which one applies depends on the service. Your plan’s Summary of Benefits and Coverage will show you which applies where.
It depends on the plan. Many plans let you use a copay for primary care, mental health visits, and prescriptions before your deductible is met. Others require you to meet the deductible first before copays kick in. Check your specific plan’s Summary of Benefits to know which services are copay-first.
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