Copayment
Copayment is commonly referred to as copay. It is a fixed amount you pay for a covered health care service, usually at the time you receive the service.
• $25 for a primary care office visit.
• $100 for an emergency room visit.
The amount can vary by the type of covered health care service. There are usually different copayments for drugs, lab tests and visits to specialists.
Generally plans with lower monthly premiums have higher copayments. Plans with higher monthly premiums usually have lower copayments.
One of the results of the Affordable Care Act was that after 2014 copays count toward the out-of-pocket maximum.
However, they do not have to count toward the deductible. There are a few plans that do count copay toward meeting the deductible but they are the exception.
Consult either your plan’s benefits description or call the customer service number on your insurance card to be sure.
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