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Insurance is designed to save you money in the long-term, but there are upfront cost to maintain a policy. These out-of-pocket expenses range due to the medical service provided and the intention of the expense. One of the most common expenses you'll encounter is the copay.


What’s a copay? It’s your part of the cost of a claim that you make to your insurance company. Very often when you make a claim, you pay a small part of the cost, and your insurance company pays the rest. The part you pay is called a copay because you’re jointly paying for your health service with your insurance company.

How much will my copays cost? That depends on the type of insurance plan you buy and the terms of that plan. Usually, copays are calculated in one of two ways:

  • Via flat fees
  • Via percentages

A copay is most often a flat fee. No matter how your copays are calculated, they usually differ between services.

 Let’s say you go to the doctor because you have a cough. If your plan involves copays, you’ll usually pay for part of your doctor’s visit. Your copay could be anywhere from tens to hundreds of dollars. For the sake of example, let’s say that your insurance plan charges you $40 for a doctor’s visit. Your doctor prescribes antibiotics. You go to the pharmacy and pick up your prescription. You’ll usually pay a different copay for your drugs, perhaps a lower one or perhaps a higher one. Again, for example, let’s say your prescription costs you $10.

Your cough gets worse, and you go to the hospital. You’ll pay a different copay for your care at the hospital than you did for either your doctor’s visit or your medicine. Maybe your copay for a trip to the emergency room is $150. You see a pulmonary specialist at the hospital. Often, your copay for seeing a specialist is higher than your copay for seeing your regular doctor. This time, it’s $50. If you were the patient in this example, your medical care would have cost you $250. However, your insurance company would have paid hundreds, perhaps thousands, more of the expense of your care. That’s the benefit of a copay—you pay a small, fixed amount for your care, and your insurance company pays the rest.

Do I have alternatives to copays? Yes. Your plan might involve a similar feature called coinsurance. You might also have a plan that requires you to pay few to no copays but then costs you more in other ways. HealthMarkets Insurance Agency can answer your copay questions.

At HealthMarkets, we specialize in comparing insurance policies. Use our free online tool to get insurance quotes in seconds, or you can call one of the thousands of licensed agents who can help you understand which plans involve copays and how much they’ll cost you. Making the right health insurance choices is important; let HealthMarkets give you peace of mind.


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