Copayments

Copayments, or copays, are fixed amounts that patients pay at the time they receive a health care service or fill a prescription, as part of a cost-sharing arrangement with an insurer or government program. They are a common feature of many health insurance plans and are intended to share the cost of care between the insurer and the patient.

Copays differ from coinsurance, which is a percentage of the cost, and from deductibles, which are amounts patients must pay before coverage begins. They are typically specified in plan documents and can vary by service type, provider, or drug tier. Common examples include a $20 copay for a primary care visit, a $40 copay for a specialist visit, or a set prescription drug copay that differs for generics and brand-name medications. Some services may have no copay or may be exempt from copays altogether.

In many systems, certain services are exempt from copays, such as preventive care in some countries and under specific laws, or emergency services may be treated differently. Copays are intended to reduce unnecessary use of services and help moderate overall health care costs, but they can pose barriers to access for low-income individuals or those with chronic conditions if the amounts are high relative to income or frequency of care.

Policy considerations include aligning copays with value of services, implementing caps on out-of-pocket costs, providing income-based exemptions or waivers, and ensuring essential care remains affordable. Global practice varies: some countries rely more on taxes and universal coverage with limited copays, while others maintain more substantial patient fees.