Healthcare Insurance: What Is a Copayment?

Fran Majidi
August 21, 2019

A copayment or copay is a fixed amount you pay when you see your doctor or pay for any health care service. Usually, copays are between $15 and $55 and differ according to different health plans. Copays are not the same as coinsurance, which is a set percentage that your insurer is responsible to pay along with a percentage you’re responsible to pay. For example, a 60/40 split means your insurer covers 60% and you pay for $40. If your physician charges $100, you pay $40 out of pocket and your insurer pays the rest. 

Under Medicare Part A, 20% coinsurance may apply to durable medical equipment used for home health care.

Medicare Part B deductible in 2019 was $185 a year. This means you pay that much before Medicare Part B begins to cover expenses. Screenings and preventive services covered by Medicare Part B do not require any Medicare copays or coinsurance. However, you may be responsible for 20% of some services. There is a maximum on how much a physician or other health care provider can be paid by Medicare.

Medigap or Medicare Advantage plans are private health insurance plans that can help supplement an Original Medicare coverage. You pay a premium and Medigap pays for out-of-pocket costs like deductibles, copays, and coinsurance.

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