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Knowing what a copay is in health insurance can help you understand what your out-of-pocket expenses will be. At the time of service, copay amounts are usually required in order to receive particular medical services. If your copays and other out-of-pocket expenses are unaffordable, some individuals may qualify for cost-sharing subsidies that can help lower those costs. 

Copay, short for copayment, is a fixed amount based on your insurance plan and the type of health care provider you are visiting. When you visit a medical professional, you are charged by the facility for the visit. You make your copayment, receive your required medical services, and your provider is billed for the rest of the cost. This doesn’t include any coinsurance or deductible payments you may have to cover.

Examples of medical services that a copay covers are prescription drugs and doctor, specialist, urgent care, and emergency room visits. Copay amounts are generally lower for doctor visits and can increase for services such as those received in an emergency room or for certain prescriptions. Each service may require a different copay cost depending on your insurance plan.

Copayment Subsidies

Some qualifying Americans may be eligible for copay subsidies that can either lower or cover copay expenses. Cost Sharing Reduction Subsidies (CSR) offer lower out-of-pocket costs based on income for some eligible plans. These lowered costs include copayments, deductibles, and coinsurance.

Your household income determines eligibility for copay subsidies. Measured per household, how far on the Federal Poverty Line (FPL) your income falls determines eligibility coverage.

What To Do Next

If you’re finding it hard to meet your copays, or are still unsure of what a copay is in health insurance, let the licensed agents at HealthMarkets Insurance Agency help. Our agents can help you navigate insurance policies to find the right plan for your medical and budgetary needs. We can work with you to see if you qualify for federal subsidies for the coverage you need at the price that’s right for you.

Give us a call today at (800) 360-1402 or get a quote online.




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