A fixed amount of money an insured person pays out-of-pocket for a covered healthcare service, typically at the time the service is rendered. Copays are set by insurance plans and are usually a specific dollar amount (e.g., $20 per doctor visit) or a percentage of the total cost of the service.
A contract between an individual and an insurance company that outlines the coverage, benefits, and terms of the insurance policy. Copays are often specified within these plans.
Expenses that an insured individual must pay on their own, without assistance from their insurance company. Copays are one type of out-of-pocket cost.
A healthcare provider, typically a doctor, who serves as the main point of contact for an individual’s healthcare needs. Copays for visits to a PCP may be different from those for specialist visits.
A healthcare provider with expertise in a specific area of medicine or healthcare, such as a cardiologist or orthopedic surgeon. Copays for specialist visits are often higher than those for primary care visits.
Medications prescribed by a healthcare provider to treat a specific condition or illness. Some insurance plans require copays for prescription drugs, which can vary depending on the type of medication and whether it is generic or brand-name.
A healthcare provider or facility that has contracted with an insurance company to provide services at a discounted rate to members of that insurance plan. Copays for services received from in-network providers are typically lower than those for out-of-network providers.
A healthcare provider or facility that does not have a contract with a particular insurance company. Copays for services received from out-of-network providers are often higher, and the individual may be responsible for paying a larger portion of the cost.
The amount of money an insured individual must pay out-of-pocket for covered services before their insurance company begins to cover costs. Copays may still be required even after the deductible is met.
The maximum amount of money an insured individual is required to pay out-of-pocket for covered services during a specific period, typically one year. Once the MOOP is reached, the insurance company covers 100% of covered costs, including copays.