Copayment (Copay)
Definition current for the 2026 plan year · Last reviewed July 2026
In one sentence: A fixed fee per service — e.g., $30 per doctor visit — regardless of the underlying bill.
A copay is a flat fee per service — $30 to see a doctor, $15 for a generic prescription, $500 per ER visit — regardless of what the underlying care costs. Predictability is the point: you know the price walking in.
The detail that separates good plans from mediocre ones at the same premium: whether copays apply before the deductible. Many silver and gold plans give you copay-based doctor visits and generics from day one, with the deductible reserved for hospital-level care. Many bronze plans don't — you pay the full negotiated price for everything until the deductible is met. Two plans with identical premiums and deductibles can differ by hundreds of dollars a year for a family that actually visits doctors.
Copays count toward your out-of-pocket maximum but usually not toward the deductible. Check the plan's Summary of Benefits ("services covered before you meet your deductible" line) — it's a one-page document and this is its most valuable row.