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Copay vs Coinsurance: what is the difference?
A copay is a fixed dollar amount, such as $20, for a covered service. Coinsurance is a percentage of the allowed amount, such as 20%, usually after the deductible.
Facts only, from 4 cited sources, checked October 23, 2026. This page does not recommend either option.
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Copay vs Coinsurance side by side
| Copayment | Coinsurance | Source | |
|---|---|---|---|
| Form | Fixed dollar amount | Percentage of the allowed amount | HealthCare.gov glossary: Copayment |
| HealthCare.gov example | $20 for a covered service | 20% of a $100 allowed amount = $20 | HealthCare.gov glossary: Coinsurance |
| When it applies | After the deductible in many plans | After the deductible | HealthCare.gov glossary: Coinsurance |
| Counts toward the out-of-pocket maximum | Yes, for in-network covered care | Yes, for in-network covered care | HealthCare.gov glossary: Out-of-pocket maximum/limit |
| Original Medicare Part B | Not the usual cost-sharing form | Usually 20% of the Medicare-approved amount | Medicare.gov: Medicare costs (2026) |
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What is the difference between Copay and Coinsurance?
A copay is a fixed dollar amount, such as $20, for a covered service. Coinsurance is a percentage of the allowed amount, such as 20%, usually after the deductible.
Which costs more, a copay or coinsurance?
Neither is always higher. A copay stays the same; coinsurance rises with the allowed amount of the service.