What is a Copay?

Health insurance 101 terms to know

A copay is a set amount that you pay directly to a doctor or a hospital for covered care or services. Copayment amounts may be different depending on the kind of care or service you are getting. For example, your copay for a regular doctor office visit may be $30, but your copay for a visit with a specialist may be $60.

Do copays count towards my deductible?

Copays often do not count towards your deductible, but refer to your plan documents to see the details of your plan. If you meet your deductible, you will still owe copays for certain covered services. But your copays do count towards your out-of-pocket (OOP) maximum. Only when you reach your OOP maximum does your copay go away. When you reach your OOP maximum for the year, your plan covers 100% of the cost of your care for the remainder of your plan year.

What is the difference between a copay and coinsurance?

A copay is a fixed-cost amount, but when you pay coinsurance, you pay a portion of the total cost of your care. Coinsurance kicks in after you have reached your deductible. For example, if you get a surgery that costs $4,000 and you have 20% coinsurance, you would pay $800 and your plan would pay the remaining 80%, which would be $3,200.

Where can I find out what my copay amounts are?

You can review your copay amounts by looking at your Summary of Benefits and Coverage (SBC) in the Blue Cross of Idaho member app. Go to your profile, select Medical Coverage and then Summary of Benefits and Coverage at the top of the page. You can also find this information by logging into your account at members.bcidaho.com, hovering over Benefits & Coverage and selecting Summary of Benefits & Coverage.

Download the member app

Have questions about other health insurance terms? You can find the definitions for common terms in the Blue Cross of Idaho member app. Go to your profile and then select Resources at the bottom of the screen to find FAQs and other helpful information. Don't have the app? Download it in the App Store or Google Play Store today!

Posted: January 5, 2022