Copayment
A fixed dollar amount a patient pays for a covered health care service, usually at the time of the visit.
Updated
A copayment (often called a copay) is a fixed dollar amount a patient pays for a covered health care service, such as a primary care visit or a prescription drug. The amount is defined by the plan and is typically due at the time of service.
Copayments often apply to specific service types and may differ between primary care, specialist visits, emergency department visits, and prescription tiers. Some plans apply copayments before the deductible is met for certain services.
In practice
In billing, copayments appear as a flat patient-responsibility amount on the explanation of benefits and are often collected at check-in. They are posted as a fixed dollar figure rather than a percentage of the allowed amount.
Commonly confused with
- Coinsurance: Coinsurance is a percentage of the allowed amount; a copayment is a fixed dollar amount per service.
- Deductible: A deductible is a cumulative amount paid before the plan shares cost; a copayment is a per-service charge.