Health Plans
What is Copay?
Definition
A copay is a flat, predictable fee the member pays at the time of service — typically $10 to $60 for a primary care visit and $30 to $90 for a specialist. Copays generally do not count toward the deductible but do count toward the annual out-of-pocket maximum.
Real-World Example
A parent takes a child to urgent care and pays a $50 copay at check-in. The insurer settles the remaining $340 with the provider under the negotiated network rate.
Why It Matters
Copays are the cost that most policyholders actually feel. Plans that swap coinsurance for tiered copays are easier to budget, especially for families with recurring prescription refills.
Frequently Asked Questions
Do copays count toward the deductible?
Usually not. They apply to the out-of-pocket maximum but rarely reduce the deductible.