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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 ?
Currently, the Medicare home health benefit does not impose a copayment on its beneficiaries, but many in Congress and the administration are weighing the possibility of saddling a vulnerable population with additional out-of-pocket costs.
Much of the evidence of copayment impacts on medication adherence reflects an average effect in a population.
Furthermore, there is concern that fraud has been creeping into the system, and the commission hopes a copayment would limit such activity.
Major Finding: Eliminating the copayment for statin drugs led to a 3.
Trivedi noted that older patients often have increased health care expenses, which can make even a small copayment a substantial financial deterrent.
The Home and Community Services Copayment Equity Act of 2007 would ensure that qualified assisted living residents and dual-eligible recipients who live in other home-and community-based settings receive the same relief from Medicare Part D co-payments that nursing home residents receive.
The association urged Congress to reintroduce "The Home and Community Services Copayment Equity Act" (bill S.
In addition, questions addressed specific health care needs (both prior to and during incarceration) and assessments of the copayment system implemented in the prisons (Ammar and Weaver, 2005).
By forcing the cost of medical expenses, including potentially higher out-of-pocket copayment, coinsurance, and deductible expenses, back onto parents are we unwittingly inviting increased litigation to recover these expenses?
GAO found that use of a copayment methodology in 2003 that differed from the copayment methodology in 2002 has resulted in inaccurate 2003 copayment amounts for 75 APCs.
As a result, major news organizations have developed stories that feature consumers complaining about having to pay the full over-the-counter price for Claritin or a higher copayment for prescription allergy drugs.
Actuarial data show a $5 increase in an office visit copayment (from $5 to $10), for example, can reduce the number of office visits by 25% to 30%.