Free Assistance* from Licensed Agents
Marketplace America.org Health Insurance


What Does Copay Mean in Healthcare?

A predetermined fixed amount, such as $20, that an insured individual is responsible for paying for a covered healthcare service after fulfilling the deductible requirement. For instance, if your health insurance plan charges a $100 fee for a doctor’s office visit, and your copayment for such a visit is $20:

  • If you’ve met your deductible: You pay $20, typically at the time of the visit.
  • If you haven’t met your deductible: You pay the full allowable amount of $100 for the visit.

Copayments, often referred to as “copays,” can vary depending on the type of service, such as prescription drugs, lab tests, or specialist visits, within the same insurance plan. Generally, plans with lower monthly premiums tend to have higher copayments, while those with higher premiums usually feature lower copayments.

Key Points:

  • Copayments are fixed, upfront payments made by insured individuals for covered healthcare services.
  • They offer predictability in healthcare costs and are a standard feature in many health insurance plans.
  • Copayments may differ for various types of medical services and can vary among insurers.

“Glossary.” HealthCare.gov, www.healthcare.gov/glossary/.

“What Is a Copay? Definition in Health Insurance and Example.” Investopedia, www.investopedia.com/terms/c/copay.asp.

Find the best health insurance coverage in your state.

Get up-to-date plans and prices for individual & family health insurance.