copayment

A copayment, or copay, is a fixed amount paid by the insured at the time of receiving a covered service, with the health insurance plan covering the remainder. Copayments are a form of cost-sharing intended to share routine medical costs between the insured and the insurer. They are set by the insurance plan and can vary by service, plan type, and whether the service is preventive.

Copayments are distinct from coinsurance (a percentage of the allowed amount) and from the deductible (an amount the insured must pay before coverage applies). In many plans the copay applies for specific services even after meeting the deductible, while preventive services are often exempt from copays. Some plans waive copays for in-network services or require higher copays for out-of-network care. The total annual out-of-pocket maximum limits how much a person pays for covered services.

Common examples include fixed copayments for office visits, urgent care, and emergency department visits, as well as prescription drugs with tiers such as generic, preferred brand, and specialty. The exact amounts and what services incur a copay vary by plan and country.

Critics argue copays can deter necessary care and disproportionately affect low-income patients, while supporters say they help control spending and reduce overuse. Policy discussions often explore balancing access with cost containment, and some systems cap or exempt essential services from copayments or adjust them based on income.