Legal Glossary
Co-pay (Copayment)
A fixed dollar amount you pay for a covered healthcare service at the time of the visit, separate from your deductible.
Legal Definition
A copayment (commonly called a co-pay) is a fixed, predetermined dollar amount that an insured person pays for a covered healthcare service at the time the service is received — regardless of the total cost of the service. Co-pays are separate from and in addition to your deductible and co-insurance. They're commonly used for primary care visits, specialist appointments, urgent care, emergency room visits, mental health visits, and prescription drugs. The specific co-pay amounts are specified in your insurance plan's Summary of Benefits and Coverage (SBC).
In Plain English
A co-pay is the flat fee you pay at the doctor's office. If your insurance has a $30 co-pay for primary care visits, you pay $30 every time you see your primary care doctor — regardless of what the doctor actually charges. Your insurance pays the rest (after any deductible, if applicable). Co-pays for specialist visits are usually higher than for primary care; emergency room co-pays are usually the highest. Importantly, co-pays don't always count toward your deductible — check whether your plan has 'deductible-first' requirements for certain services, which means you pay the full allowed amount for that service until your deductible is met, with the co-pay applying only after.
Real-World Example
Tom's health insurance plan has these co-pays: $25 for primary care, $50 for specialist visits, $100 for urgent care, and $350 for emergency room. When he visits his primary care doctor for a cold, he pays $25 at the front desk — that's his co-pay. When he's referred to a cardiologist, he pays $50 at that visit. These co-pays are fixed and predictable regardless of how much the visit actually costs the doctor to perform.