What is a copay?

What is a copay?

• A. Annual out-of-pocket maximum
• B. Fixed amount paid per visit/service
• C. Monthly premium
• D. Percentage of total costs

Answer: (B)

A copay is a fixed dollar amount you pay at the time you receive a covered medical service or prescription. This amount is set by your plan and is paid upfront, regardless of the total charge for the visit or service. It’s different from a monthly premium (the regular payment to maintain coverage) and from the annual out-of-pocket maximum (the cap on what you pay in a year). It’s also not a percentage of the bill—that would be coinsurance. For example, if your plan has a $25 copay for a doctor’s visit, you pay $25 at the visit and the insurer covers the rest per the plan’s rules. Copays can vary by service type and by plan.

A copay is a fixed dollar amount you pay at the time you receive a covered medical service or prescription. This amount is set by your plan and is paid upfront, regardless of the total charge for the visit or service. It’s different from a monthly premium (the regular payment to maintain coverage) and from the annual out-of-pocket maximum (the cap on what you pay in a year). It’s also not a percentage of the bill—that would be coinsurance. For example, if your plan has a $25 copay for a doctor’s visit, you pay $25 at the visit and the insurer covers the rest per the plan’s rules. Copays can vary by service type and by plan.