What is a Copay?
A copay is a fixed amount you pay for a service. Usually they range from $5-$75 depending on the type of care.
Understanding Copays
Copays are one of the more traditional forms of payment for a doctor’s services. They are usually a fixed cost, or a flat fee, per visit, and do not vary throughout your plan year. A patient typically pays a copay at the time of service.
Common Copay Amounts
Copays vary in price by provider speciality and by the network status.
Copay by Speciality: Usually primary care providers (PCPs) have the lowest copays, typically ranging from $10 to $50. Urgent Cares and Specialist copays are higher, typically ranging from $30 to $100. Emergency room copays are typically the highest, and may cost more than $200.
Copay by Network Status: In-network copays tend to be lower than out-of-network copays.
What Kinds of Plans Have Copays?
Copays are most common HMO or PPO plans, and are not common on High Deductible Health Plans (HDHPs).
Do Copays Cover Everything?
A simple visit to your primary care doctor may be fully covered by a copay, but most copays do not include services that are considered beyond the scope of that provider. For example, you may pay a copay to see your cardiologist, but you may receive a separate bill (not covered by your copay) from the third-party lab who analyzed your blood sample.
How Do I Know How Much my Copay Costs?
Most insurance cards list the copays on the front of the card to make it easy for the patient and the provider to pay or collect money up front. If your card does not have the copay listed, you can look at your plan benefit documents or call the phone number on the back of your insurance card.
Related Terms
PPO Plan
In-Network
Out-of-Network