Learn more about copays and when to pay them below. To find out how copays work with other health care costs, see paying for health care.
When do I have a copay?
Not all health plans have copays. It's important to look through the plan enrollment materialsto find out if a plan requires copays.
Here are some common medical services that may require a copay:
- Office visit to see a doctor or specialist
- Urgent care visit
- Emergency room visit
- Prescriptions
Usually, plans with a high deductible do not require office visit or prescription drug copays.
When do I pay the copay?
You pay a copay at the time of service. Copays do not count toward your deductible. This means that once you reach your deductible, you will still have copays. Your copays end only when you have reached your out-of-pocket maximum.
Copay example
Here’s an example of how copays works:
Mary visits her primary care doctor to discuss her flu symptoms. Her plan requires a $25 copay for the visit. Mary pays the $25 copay to the receptionist when she arrives for her appointment.
During her office visit, Mary’s doctor sends her to the lab to have blood drawn.Since Mary‘s $25 copay doesn’t cover lab work, she will have additional costs to pay:
- If Mary has not met her deductible, she receives a bill for the cost of the lab services. Her health plan applies this amount to Mary’s deductible.
- If she has met her deductible, Mary pays only a percentage of the cost (known as coinsurance) for the lab workand her health plan pays the rest.
