FAQ: What Is A Copayment?

Typically an insurance policy will have a deductible, 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 choose future health care plans.


What Is A Copayment?

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.

Although it may seem complex, understanding health insurance coverage will be helpful. You may even start noticing how some ads can be misleading. Especially to those who aren’t as familiar with health insurance. 

Some insurance commercials claim that their plans don’t have copays or deductibles. These plans may sound great, but the money being “saved” has to come from somewhere. Whether it’s by charging you high monthly payments or limiting the doctors you can see. 

A good rule of thumb is if it seems too good to be true, it probably is. Look further into the plan to see just how “perfect” it really is.

Using your new knowledge about health insurance plans will allow you to better decide whether those plans are right for you and your family.

For more information about health insurance, click here.

About The Author

Jaime Curl

I've explored many different fields within physical therapy, including acute care and oncology at Troy Beaumont Hospital, elementary through high school levels in the Troy School District, and outpatient physical therapy. As the office manager and marketer, I am able to combine my love for health and exercise science with my people skills, all with a dash of marketing and personal training. My hobbies include spending time with friends and family, baking, crafting, and watching my favorite movies or tv shows.

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