Copay
A fixed dollar amount you pay for a covered healthcare service at the time of care.
What is Copay?
A copay (or copayment) is a fixed, predetermined dollar amount that a health insurance policyholder pays at the point of receiving a covered healthcare service — such as $25 for a primary care visit, $50 for a specialist, or $15 for a generic prescription. Unlike coinsurance, which is a percentage of the total allowed cost, a copay is a flat fee regardless of the total charge. Copays may apply before or after the deductible is met, depending on the plan's design — some plans apply copays immediately for routine services while the deductible applies only to more costly care. Copays count toward the plan's out-of-pocket maximum. Plans with lower premiums typically have higher copays, while higher-premium plans often feature lower or $0 copays. Understanding your plan's copay structure is essential for estimating total healthcare costs, especially for frequent users of primary or specialist care.
Example
A policyholder's plan has a $25 primary care copay and a $60 specialist copay. She visits her doctor twice a year ($50 total) and sees a cardiologist once ($60). Her total copay spend is $110 for the year, regardless of what those visits would have cost without insurance. Each copay also applies toward her $6,000 out-of-pocket maximum.
Source: HealthCare.gov — Glossary: Copay