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What is a copay?

A copay, also called a copayment, is a determined amount of money beneficiaries pay to their healthcare provider for healthcare visits, prescription drugs and other services.  

The type of care, such as specialty care or urgent care, determines the copay amount. Generally, copays begin at around $10. Additionally, copays often don’t count toward deductibles, meaning individuals pay a copay regardless of whether they’ve reached their deductible.  

What’s the difference between coinsurance and copays? 

While copays are a determined amount of money members pay for healthcare services, coinsurance is a set percentage of costs that members pay after reaching their deductible. 

Why are copays important to healthcare?

Copays are important to healthcare because they share the cost of medical care between the policyholder and the insurer, whether Medicare, private insurers or Medicaid. Plans created shared-cost copays to reduce unnecessary care.