A prearranged, specific amount of money a policyholder pays for healthcare services such as doctor visits and prescription drugs when treatment is received. In exchange for payment of premiums, the insurance company pays the remainder of the costs involved, often easing the financial burden on the insured considerably.
In this day of managed healthcare, most Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) offer services with set copays. As long as the policyholder seeks care within the insurance company’s network of providers, these networks cover services at greatly reduced prices, and the insured is responsible only for a copay.
Though copay amounts depend on the type of service provided, its cost to the provider and the terms of the insurance policy, copays for common services usually range between $5 and $25. However, the insured can expect higher copays for more specialized services.
When a policyholder carries both primary and secondary insurance, the primary insurer picks up the majority of the tab and the secondary picks up additional costs like copays.