img Explainer

What is a Copayment?
ONC Editorial

May 31, 2023

This Explainer discusses the meaning of copayments in health plans.

Copayments, or copays, are set fees that insured people must pay for medical care. Though not all health plans include copays, a majority of health plans do. Copays also vary based on an individual’s insurance provider, insurance plan and monthly premiums. For example, people with lower monthly premiums usually have to pay higher copays when they receive medical service.

The average insured person often has to pay a copay for a doctor’s appointment, an urgent care visit, an emergency room visit and a prescription. Copays are usually paid at the time the service is performed or the prescription is received. It is important to keep in mind that copays are not the same as deductibles and that copays do not count toward an individual’s deductible. For example, if your deductible was $100 and your copay was $30, the performed health care service would need to be over $100 in order for insurance to intervene.

Copays are usually fixed amounts and are known by the policyholder before the appointment, office visit or prescription pickup. Copays extend past office visits and prescriptions to include physical therapy, speech therapy, mental health counseling and ambulance rides. They also range from all sorts of different services. Copays for doctor’s visits tend to be less expensive than those for specialist visits, such as emergency room visits, et cetera.

To see all sources consulted/reviewed/interviewed for the purposes of writing this article and/or to learn more about this article’s author, click here.

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