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What Is an Insurance Copay?

Many people rely on some form of health insurance to help pay for routine, preventative, and emergency medical treatment. If you've ever been asked to pay a relatively minor amount of money when seeing a doctor or filling a prescription, then you've made a copayment (also known as a "copay"). Copays represent your responsibility for the cost of your own medical care, once you have met your deductible. Read on to learn more about insurance copays.

Copays Defined

A copay is a flat fee that you may be required to pay out-of-pocket when you go to the doctor or fill a prescription. Copays are a specific dollar amount, not a percentage of the bill, and typically are owed up front at the time of treatment or visit. The amount of your particular copay is sometimes printed directly on your insurance card. If not, check your insurance policy or contract for specifics. The amount of the particular copay will also vary for different services within the same plan. For example, a specified copay will often be different for services like:

  • Annual check-ups
  • Prescription drugs
  • Emergency room visits
  • Lab tests
  • Visits to specialists

Some insurance policies pay 100% of the cost of certain types of care, like annual check-ups and preventative care, so you wouldn't have to make any copayment for this type of visit. Copays for other types of doctor's office visits typically cost around $25 or less, while copays for emergency room visits tend to be higher.

Interplay Between Deductibles, Premiums, and Copays

To understand copays, it's helpful to also understand deductibles and premiums, because all of these work together to determine how you and your insurance company share responsibility for payment of your medical services. An insurance premium is the amount of money that you pay to the insurance company in exchange for insurance coverage. Premiums impact copays in that typically, if you have a plan with lower monthly premiums, you will end up having a higher copay, while plans with a higher monthly premium will have a lower copay.

Deductibles also impact copays. A deductible is a set amount that you're required to pay under your insurance policy before your health insurance begins to pay. If you have a higher deductible under your policy, you will likely have to pay for most minor services until you reach your deductible. After that, all that you're responsible for (if the expense if covered by your policy) is the copay, and your insurance company will cover the rest. However, you have to meet your deductible first before your only responsibility is a copayment.

Get Legal Help with Copay or Insurance Issues

Insurance issues can be complex, and unfortunately conflicts with insurance companies often arise. If your insurance company has declined certain coverage, or has charged a copay that seems inconsistent with your insurance policy or contract, you may want to seek independent legal counsel. FindLaw can help you find an experienced insurance lawyer in your area.

Next Steps
Contact a qualified attorney to assist with
any issues related to insurance.
(e.g., Chicago, IL or 60611)

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