What is a copay?
Learn about copays and when to pay them.
A copay (or copayment) is a set fee you pay for a doctor visit or prescription.
You typically pay it at your appointment or when you pick up a prescription.
When do I have a copay?
Not all health plans have copays. It's important to look through the plan enrollment materials to find out if a plan requires copays.
Here are some common medical services that may require a copay:
- Office visit to see a doctor or specialist
- Urgent care visit
- Emergency room visit
- Prescriptions
Usually, plans with a high deductible do not require office visit or prescription drug copays.
When do I pay the copay?
You pay a copay at the time of service. Copays do not count toward your deductible. This means that once you reach your deductible, you will still have copays. Your copays end only when you have reached your out-of-pocket maximum.
Learn more
Find out how copays work with other healthcare costs and learn how and who to pay for healthcare.
How copays work
Example of how copays work
Mary visits her primary care doctor to discuss her flu symptoms. Her plan requires a $25 copay for the visit. Mary pays the $25 copay to the receptionist when she arrives for her appointment.
During her office visit, Mary’s doctor sends her to the lab to have blood drawn. Since Mary‘s $25 copay doesn’t cover lab work, she will have additional costs to pay:
If Mary has not met her deductible ...
She receives a bill for the cost of the lab services. Her health plan applies this amount to Mary’s deductible.
If Mary has met her deductible ...
She pays only a percentage of the cost (known as coinsurance) for the lab work and her health plan pays the rest.
This is general information about how plan benefits work. Review the Summary of Benefits and Coverage and your specific health plan benefit booklet for information about how your plan works.
*It’s up to you to always check if your provider is in your health plan network before you receive services. Not all providers are in every network. You may pay more or for all of your healthcare costs if your provider is out of your network or does not have a contract with Blue Cross (this is called a non-participating provider). You can verify if your provider is in your network by calling customer service at the number on the back of your member ID card.