Copay (Copayment)
A fixed amount you pay for a covered healthcare service at the time of the visit.
What is Copay (Copayment)?
A copay (or copayment) is a fixed dollar amount you pay when you receive a covered healthcare service. For example, you might pay a $25 copay for a doctor's visit or $15 for a generic prescription. The insurance company pays the rest.
Copays are typically the same regardless of the actual cost of the service. You might pay the same $40 copay whether the doctor bills $200 or $400. This makes costs more predictable compared to coinsurance, where you pay a percentage.
In high-deductible health plans, you usually don't have copays until you meet your deductible - you pay the full allowed amount for services. Some HDHPs do offer copays for certain services like preventive care or generic drugs.
Frequently Asked Questions
Do copays count toward my deductible?
It depends on your plan. Some plans count copays toward your out-of-pocket maximum but not your deductible.
Are copays the same for all services?
No. Plans typically have different copays for different services: primary care, specialists, urgent care, ER, and prescriptions often have different amounts.
Can I use HSA for copays?
Yes. Copays for qualified medical services are HSA-eligible expenses.
Related Terms
Coinsurance
The percentage of costs you pay for covered healthcare services after meeting your deductible.
Deductible
The amount you must pay out-of-pocket for healthcare before your insurance starts covering costs.
Out-of-Pocket Maximum
The most you'll pay for covered services in a plan year, after which insurance pays 100%.
Related HSA Expenses
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