FAQ: What Is A Copayment?

Typically an insurance policy will have a deductible, a coinsurance or copayment and an out of pocket maximum. Although every insurance plan is different and may not have each of these, it’s important to understand them and how they work. It’s especially useful when it comes time to choosing future health care plans.

A copayment (also referred to as a copay) is a nice, round dollar amount you pay for health care services after you’ve paid your deductible.

  • For example, Dwayne’s health insurance plan’s cost for a doctor’s visit is $100. His particular plan has a copayment charge of $15 for office visits.
  • If Dwayne has already met his deductible, then he will only be responsible for paying $15 at the time of service.
  • If he hasn’t met his deductible however, he will pay $100, the full allowable amount for the visit.

For the most part, all insurance plans have some sort of copay for one service or another. Copayment amounts can vary for different services. You may have a $30 copay for specialist visits yet have a $50 copay for lab tests. Some services may not require a copay at all.

For more information regarding insurance benefits, visit www.borjapt.com/blog/health-insurance-101.

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Jaime Curl

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