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What Is a Copayment in an Insurance Plan?

A co-payment, commonly referred to as a co-pay, is one of a patient's possible costs when visiting a hospital, clinic or private doctor. A patient may be allotted a specific number of doctor visits per year for which he pays a co-pay, after which he begins paying out-of-pocket until his deductible is met.

  1. What is a Co-pay?

    • A co-pay is a flat, predetermined payment due prior to service at a medical facility. Co-pays must be a small enough amount that they do not create a "barrier to service" for the patient and they are not affected by the cost of the service provided by the facility. Co-pays may range from $5 per visit to $50 or more.

    Are Plans Without Co-Pays Available?

    • In short, no. The co-pay can be very low for some high-premium plans, but virtually all plans require a co-pay of some sort for service.

    Are Prescription Drugs Included?

    • Although co-payments are consistent for most types of treatment, prescription drugs are often tiered and require different levels of co-pay.

    In Network? Or Out of Network?

    • Co-pay amounts for identical services often vary depending on whether the patient visits an "in-network" or "out-of-network" provider.

    Additional Information

    • Co-insurance is not the same as a co-pay, but is a common feature of many health insurance plans. When a patient's insurance offers co-insurance, it is in the form of a percentage, for example, if the co-insurance rate is 30%, the insurance company will pay 70% of the covered costs and the patient is responsible for the rest.

      Typical insurance coverage requires a patient to pay a certain amount prior to being reimbursed for medical costs, this charge is referred to as a deductible. The amount of the deductible varies depending on the coverage and is usually tied to the cost of the monthly premium--as the premium rises, the deductible lowers; the opposite is also true. When a patient has a co-pay, he does not have to meet his deductible to use it, but neither is the co-pay amount applied to the deductible.

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