Glossary · Costs
What is a copay?
A copayment, or copay, is a fixed dollar amount you pay for a covered health care service, such as $20 for an office visit. Under many plans it applies after the deductible is met.
Definition and figures from HealthCare.gov glossary, Medicare.gov, checked October 23, 2026. This page explains the term; it does not recommend a plan.
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Copay (copayment): the facts
| Item | Fact | Source |
|---|---|---|
| Example from HealthCare.gov | A fixed amount, such as $20, for a covered service | HealthCare.gov glossary: Copayment |
| In network vs out of network | HealthCare.gov examples: $15 in network, $30 out of network | HealthCare.gov glossary: Out-of-network copayment |
| Medigap Plan N (2026) | Copayment of up to $20 for some office visits and up to $50 for ER visits that do not lead to admission | Medicare.gov: Compare Medigap plan benefits |
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Related terms
Questions
What does copay mean in health insurance?
A copayment, or copay, is a fixed dollar amount you pay for a covered health care service, such as $20 for an office visit. Under many plans it applies after the deductible is met.
Does a copay count toward the deductible?
It depends on the plan. Copays count toward the out-of-pocket maximum for in-network covered care. Whether they count toward the deductible is set in the plan's documents.
What is the difference between a copay and coinsurance?
A copay is a set dollar amount. Coinsurance is a percentage of the allowed amount.