A co-pay, or copayment, is a fixed amount you pay for a covered health care service, such as $20 for a doctor visit.
It's the cost most people actually feel at the front desk: you hand over a card, the receptionist names a number, and that's your co-pay. The rest of the visit is between your insurer and the provider. Co-pays are one of several ways your plan splits costs with you, alongside the deductible, coinsurance and your monthly premium.
The word is spelled "co-pay," "copay" and "copayment" interchangeably. HealthCare.gov's glossary entry is titled Copayment and notes that copayments are sometimes called "copays."
What a co-pay is
HealthCare.gov's example goes like this. Your plan's allowable cost for a doctor's office visit is $100, and your copayment for a visit is $20. If you've paid your deductible, you pay $20, usually at the time of the visit. If you haven't met your deductible, you pay the full $100.
Notice that last part. In HealthCare.gov's definition, a copayment comes into play after you've paid your deductible. Real plans vary, though: the deductible entry says many plans pay for certain services before you've met your deductible, and tells you to check your plan details. So don't assume. Your plan's summary shows which services carry a co-pay and when.
A few more details from HealthCare.gov:
- Copayments can vary for different services within the same plan, like drugs, lab tests and visits to specialists.
- Generally, plans with lower monthly premiums have higher copayments, and plans with higher monthly premiums usually have lower ones.
- Copayments for in-network care count toward your out-of-pocket limit, the most you'll pay for covered services in a plan year. Premiums don't.
What it looks like
A co-pay is one piece of a family of cost-sharing terms. This table shows how they differ, using the examples the official pages give.
| Term | What it is | Example from the source |
|---|---|---|
| Co-pay | A fixed amount for a covered service | $20 for a doctor visit |
| Coinsurance | A percentage of the cost of a covered service | 20% of a $100 allowed amount is $20 |
| Deductible | What you pay for certain covered services each year before your plan starts to pay | You pay the first $2,000 with a $2,000 deductible |
| Premium | A monthly amount for coverage, whether you use services or not | Paid to the insurer every month |
| Allowed amount | The most a plan will pay for a covered service | $100 for an office visit |
| Out-of-pocket maximum | The most you pay for covered, in-network services in a plan year | After it, the plan pays 100% of covered benefits |
Original Medicare uses co-pays too. Medicare.gov says you pay a copayment to the hospital for each service you get in a hospital outpatient setting, except certain preventive services, and that this can make an outpatient service cost more than the same one in a doctor's office. Medicare's published amounts change each year, so check Medicare.gov for the current figures.
What to keep and for how long
Co-pays are small, which is exactly why they go missing. The paperwork worth keeping:
- Receipts for co-pays you paid, at least until the matching explanation of benefits and bill agree. If a provider later says you still owe your co-pay, the receipt settles it.
- Explanations of benefits (EOBs), which show what the plan allowed and what you owe. Our medical bills and EOBs page shows how to read one.
- The plan summary listing your co-pay amounts, for as long as the plan is active.
- Anything you may need for tax or account reimbursements, such as an FSA or HSA claim. See FSA vs HSA for how those work, and check IRS guidance for your own situation.
How long is up to you and your situation; there's no single rule. A sensible default is to keep co-pay receipts until the year's claims are settled and any reimbursements are done. Paperlock can read the amount and date from a photographed receipt so you can search them later, and organizing your medical records covers a system that doesn't depend on any app.