Copayment
A fixed dollar amount a health plan member pays for a specific service, such as a doctor visit or prescription, at the time of care.
Overview
Copays make routine costs predictable: a plan might charge a set fee for a primary care visit, a higher one for a specialist, and tiered amounts for generic, preferred brand, and specialty drugs. In many plans copays apply before the deductible is met for office visits and prescriptions, while hospital care falls under deductible and coinsurance. Copays usually count toward the out-of-pocket maximum. Under the Affordable Care Act, recommended preventive services in network carry no copay. High deductible plans paired with health savings accounts generally replace copays with full cost up to the deductible, a trade off that lowers premiums but shifts budgeting to the member.
Related Topics
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Preferred Provider Organization
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