What You Need to Know About Insurance Copays

Copay or copayment

Copays are the fixed amount that you are responsible for paying. Doctor office visits, ER visits and prescription drugs can all have copay amounts. However, health insurance plans are not required to have copays – copays are an added benefit, therefore copay plans are typically more expensive.

Top things you need to know about copays:

• Fixed fee
• Paid up-front at doctor’s office/pharmacy
• Required on each visit
• Can vary between services
• Copays are NOT required under ACA/Obamacare
• Copay amounts are typically found on the insurance card or in the summary of benefits
• Services commonly associated with copays:
  • Primary care physician visits
  • Specialty doctor visits
  • Urgent care center visits
  • Emergency room visits
  • Short term hospitalizations
  • Medical supplies
  • Dental care
  • Vision exams
• Other cost sharing terms to be aware of:
  • Deductible
  • Co-insurance
  • Maximum Out Of Pocket (MOOP)