What is a Copay?

By RetireMEDiQ

A health plan copay is a fixed amount you pay for covered services. Usually, you will owe your copay at the time of the service (different from coinsurance), like before you leave the doctor’s office for a normal office visit.

The purpose for copays is to ensure that you get the medical care or prescription medications you need without being deterred by the cost of care.

For example, your health plan might include a copay of $10 for an office visit to your primary care physician (or family doctor). At the time of your visit, you will pay the $10 upfront. The doctor’s office will submit the remaining bill to your insurance company.

Assuming your provider is in-network, and you received Medicare-approved services, your insurance company will cover the remaining balance.

We encourage you to confirm with your insurance company or health plan advisor:

  • Whether your plan offers copays and/or coinsurance
  • What services the copays and/or coinsurance are applied to
  • If there is a limit to the number of times you can get that service at that copay during a period of time

Like deductibles and coinsurance, it is common for plans with lower monthly premiums to have higher copays. On the other hand, plans with higher monthly premiums tend to have lower copays.

If you have questions about your plan’s benefits, copay amounts or coverage please call our team at 1-877-222-1942.

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