Copay
Updated for plan year 2026
In plain terms
A copay is a fixed dollar amount you pay for a specific covered service, for example $30 for a primary care visit or $15 for a generic prescription. Because the amount is set in advance, you know your cost before you walk in, unlike percentage-based coinsurance. Depending on the plan, some copays apply before you meet the deductible and others only after. Copays count toward your out-of-pocket maximum, but not toward your monthly premium.
A plain example
Your plan charges a $25 copay for primary care and $50 for a specialist. You see your doctor about a cough, pay $25 at the desk, and the plan handles the rest of the visit's cost. A referral to a dermatologist later that month is a flat $50, no matter what the office's full rate would have been.
Why it matters
Copays make routine care predictable, which is why copay-heavy plans appeal to people who mainly want checkups and prescriptions covered without surprises. The trade-off shows up in big events: when a service runs on coinsurance instead of a copay, your share is a percentage of a much larger bill.
A common point of confusion
A copay isn't always on top of everything else. On some plans certain copays count toward the deductible and on others they don't, and a copay for one visit doesn't cover labs or procedures ordered during it, which can be billed separately.