A copay (or copayment) is a fixed dollar amount that a patient pays out of pocket for a covered healthcare service. You pay the copay at the time of the visit; the insurance plan covers the rest. A plan might set a $30 copay for a primary care visit and a $50 copay for a specialist.
Copays are set amounts, not percentages. They don’t change based on the total cost of the service.
You’ll hear this when…
Copays are one of the first things people encounter when using health insurance. “What’s your copay?” is a standard question at check-in. Copay amounts vary by service type (office visit, urgent care, emergency room, prescription) and by plan.
In benefits discussions, copays are part of the broader cost-sharing picture alongside deductibles and coinsurance. A plan with low monthly premiums often has higher copays, and vice versa.
Copay vs. coinsurance
A copay is a flat fee ($30 for a visit). Coinsurance is a percentage (you pay 20% of the billed amount). They serve the same purpose — sharing costs between the patient and the payer — but work differently. Some services have copays, some have coinsurance, and some have both, depending on the plan design.
For a broader walkthrough of insurance terminology and how these terms fit together, see healthcare jargon for the rest of us.
Source: Centers for Medicare & Medicaid Services (CMS) — glossary of health insurance terms