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Q: What Is a Copayment?

Asked by Anonymous on October 12, 2017

What is a copayment, and how is copay different from coinsurance?

Jeff Smedsrud October 12, 2017

A copayment is a fixed payment that you owe for certain medical services. Unlike coinsurance, the size of a copayment doesn’t depend on the cost of the service. Copayments are usually charged for primary care visits and prescription drugs. You can also call copayments “copay”.

Sometimes you may be asked to give your copayment directly to a medical professional, while other times you may receive a bill from your insurance company.

To consider how copayments work, imagine that one doctor charges $250 for routine visits while another doctor charges $125. If you see both doctors – and your copay for routine visits is $20 – then you’ll owe a total of $40. The remaining costs ($230 for one doctor and $105 for the other) will be billed to your insurance company.

Note that copayments are not the same thing as coinsurance. Copayments are fixed, while your coinsurance payments will vary based on the price of a procedure.

How Is Copayment Different from Coinsurance?

A coinsurance amount is usually defined as a percentage of the cost of medical care that you would pay, with the remainder being paid by your insurance company. Copayments, on the other hand, are fixed amounts and not at all dependent on the price of any particular medical procedure or service. You can read more about coinsurance here.

Taking the Next Steps

Not satisfied with your copayments? Want to check out other plans that contribute more towards your medical costs? Learn more about the different health insurance plans available to you.

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