Copay (Medical or health-related expense)
What Is a Copay?
A copay is the fixed portion of a medical or health-related expense that you are required to pay as outlined in your health insurance terms.
If your health insurance plan requires you to pay a copayment, this is your portion of the bill for services or items. Your health insurance company will have pre-determined copayment amounts for all medical services and goods. You will usually pay your copayment directly to the medical or service provider.
How Your Copay Works
You have health insurance that you pay monthly premiums for. One winter, you come down with a bad cough and visit your doctor. Even though your doctor accepts your type of health insurance, you still receive a bill for $45. This bill is your copayment for your doctor visit.
As with many other types of insurance, health insurance can be confusing. It can be difficult to figure out how much you will owe when seeking medical care or filling a prescription. Understanding what a copayment is and how it works inside an insurance plan can help you select the right insurance plan for you and for your family.
When You May Have a Copayment
Depending on your specific plan, health insurance companies can require copayments for almost any type of service or expense. Examples of bills you may have a copayment for include:
- Prescription medications
- Emergency room or urgent care clinic visits
- Doctor visits, including specialists and your primary care provider
- Hospital admissions
- Labor and delivery
- Medical equipment
- Oxygen services
- Home health
- Lab tests
- CT Scans
Make sure to review your insurance documentation for specific details about copayment requirements, and the specific services involved. Plans with lower copayments are available, if you are looking to switch you can talk to one of our experienced agents 858-771-4087, or enter your zip code here for free health insurance quotes!
What’s the Difference Between Copay and Coinsurance?
Unlike copayments, coinsurance is a percentage of the medical bill or health care expense that you will owe. Instead of being a pre-determined and fixed amount based on the service, coinsurance is usually a fixed percentage based on the service. For example, you may be required to pay 20% of the entire bill for your doctor's office visit with coinsurance, rather than a flat $40 copayment.
Copayments and Deductibles
With some insurance plans, you may have to pay the entire medical bill unless you have met your deductible, which is the amount you must pay out of your own pocket until your insurance coverage kicks in. Deductibles are usually calculated on an annual basis. There can be both individual and family deductibles depending on your specific plan.
For instance, some health insurance plans may require you to pay $2,500 of your own medical expenses as a deductible. The company keeps track of the running total you have paid. Once you meet this amount, you may only be required to pay your copayment or coinsurance amounts.