{"id":1726,"date":"2016-06-20T16:20:33","date_gmt":"2016-06-20T20:20:33","guid":{"rendered":"https:\/\/singlecare.com\/blog\/?p=1726"},"modified":"2026-02-11T10:31:22","modified_gmt":"2026-02-11T15:31:22","slug":"healthcare-defined-copay","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/healthcare-defined-copay\/","title":{"rendered":"What is a ‘copay’?"},"content":{"rendered":"

Healthcare is a complex subject with terms that can seem like a completely different language at times. One of those terms is <\/span>copayment<\/span><\/i>, or better known as <\/span>copay<\/span><\/i>. A copay is a fixed amount paid for prescriptions or healthcare services when you visit the doctor. But like most things health insurance-related, is it really that simple?<\/span><\/p>\n

What is a copay?<\/span><\/h2>\n

For most insurance plans, every time you see a doctor after meeting your deductible you pay a set amount called a copay. A copay works as a flat-fee your general practitioner or specialist charges you for using their services. The specific amount is determined by your health insurance plan, so make sure to read the fine print. Plans with lower <\/span>monthly premiums<\/span><\/a> may have higher copays.<\/span><\/p>\n

It\u2019s important to note that copays are for commercial, employer, and marketplace insurance. Medicare and Medicaid will have different rules and recommendations than the following information.<\/span><\/p>\n

Copays are a form of cost sharing with your health insurance company. They also are intended to help deter consumers from accessing unneeded medical care. Copays can have some complicated relationships with other parts of your health insurance cost structures.<\/span><\/p>\n

Before you reach your<\/span> annual <\/span>deductible<\/span><\/a>\u2014which is the amount of money you have to pay before your insurance company will help cover your medical expenses\u2014you will foot the entire bill for a covered procedure or prescription. Once you\u2019ve reached your deductible, your<\/span> coinsurance<\/span><\/a> kicks in, meaning your plan will start being responsible for a set percentage of medical costs. This is where your medical expenses get tricky, especially since your copay does not count toward your deductible, but rather goes toward your annual <\/span>out-of-pocket maximum<\/span><\/a>.\u00a0<\/span><\/p>\n

Now, here\u2019s an example to help clear things up: You sprained your foot playing soccer and think, \u201cBoy, I\u2019m so lucky I recently met my deductible, and insurance will cover this trip to urgent care.\u201d But what you don\u2019t realize is you\u2019re responsible for your copay and coinsurance. Before you leave the doctor\u2019s office, the receptionist asks you to pay your $20 copay upfront. Two weeks later, you receive a bill for an additional $80\u2014this is your coinsurance, which in this example is 20% of any medical bill total (and in your case it was a $400 bill). Thus, for this sprained foot, you ended up paying $100. Plans often negotiate rates, so they will pay your provider a percentage of the negotiated rate before you\u2019re expected to pay your appropriate coinsurance amount.\u00a0<\/span><\/p>\n

People tend to think that once they reach their deductible, they\u2019ll be free of medical bills. However, insurance will only cover all your medical expenses once you\u2019ve met your out-of-pocket maximum, which is met by a combination of paying your deductible, coinsurance, and copays.<\/span><\/p>\n

RELATED: <\/b>What\u2019s the difference between a copay vs. deductible?<\/b><\/a><\/p>\n

What does a copay cover?<\/span><\/h2>\n

A copay usually helps cover costs at a variety of office visits. However, medical services requiring copays vary between insurance plans. Services that typically require a copay include:<\/span><\/p>\n