What is copay on health insurance?

Copay, also known as copayment or fixed copayment, is a fixed dollar amount that you pay out of pocket for specific healthcare services, such as a doctor's visit, prescription medication, or hospital stay. The copay amount is set by your health insurance plan and may vary depending on the type of service and the specific plan you have.

Here's how copay generally works:

1. You have a health insurance plan that includes a copay.

2. You visit a healthcare provider or pharmacy and receive services or medications covered by your plan.

3. At the time of service or when you pick up your prescription, you pay the copay amount directly to the healthcare provider or pharmacy.

4. The remaining cost of the service or medication is covered by your health insurance plan.

Copays are meant to be affordable fixed expenses for healthcare services, allowing you to budget and plan for your healthcare costs. However, it's essential to note that copay amounts can vary significantly between health insurance plans and can even differ for different services within the same plan.

Some health insurance plans may have copays for primary care visits, specialist visits, emergency room visits, urgent care, physical therapy, and more. Some plans may also have copays for specific types of prescription medications or tiers of medications (for example, generic vs. brand-name).

It's important to carefully review your health insurance plan's summary of benefits and coverage (SBC) or contact your insurance provider to understand the copay amounts and other cost-sharing requirements associated with your specific plan.