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In insurance, a fee that a policyholder must pay for certain covered items for which the insurance company otherwise pays. For example, a check-up with a doctor may cost the policyholder a copayment of $25, with the insurance company paying for the remainder of the cost due. A copayment is also called a co-pay and should not be confused with a deductible. It exists to discourage policyholders from abusing the insurance policy.


If you have a managed-care health insurance plan, your copayment is the fixed amount you pay -- often $10 to $25 -- for each in-network doctor's office visit or approved medical treatment

In some plans, the copayment to see a specialist to whom you're referred is higher than the copayment to visit your primary care physician. Some plans may not require copayments for annual physicals and certain diagnostic tests.

If you see an out-of-network provider, you are likely to be responsible for a percentage of the approved charge, called coinsurance, plus any amount above the approved charge.

References in periodicals archive ?
While waiving or lowering copays "can feel like we're giving up hard-fought ground," Boehm said, it's really about maintaining patient accountability.
Before that happens, however, plans offering three-tiered copays will need to do a better job of educating patients about how the system works, according to Judith Cahill, executive director of the Academy of Managed Care Pharmacy, an Alexandria, Va.
Based upon the combined information, pharmaceutical marketers will be empowered with information to make crucial modifications in the scope, handling and promotion of copay offset cards.
On Monday, it was announced that the Health Ministry's "Concept for better health care 2010 - 2015" is planning changes, which envision that patients should copay for treatment in hospitals.
The biggest change, of course, is that premiums have increased substantially To help offset these costs, members with traditional plans have been forced to absorb more out-of-pocket risk in the form of higher copays, bigger deductibles, and increased coinsurance amounts.
3% of the prescriptions (117,330 claims) had a copay offset applied to the member share.
The staff should use their records of each patient's copay and add that to the amount paid, and then divide that total by the amount of the office fee.
79% of transportation employees pay $25 or more in office visit copays
The Governor also expresses concerns for the financial consequences a home health copay would have on state Medicaid programs.
Along the lines of federal block grants, the Blue Cross Blue Shield Association supports the inclusion of a tiered copay system into any Medicare pharmacy program.
Available to consumers from 18 to 64 1/2 years old, the product offers a choice of deductibles and coinsurance levels, and it has a copay system for nonpreventive office visits to a network provider and discounts at network hospitals.