Even with insurance, patients usually pay something at the point of service. A copayment is a fixed dollar amount that the insured must pay for a covered healthcare service, such as a doctor visit or prescription, while the insurer pays the balance of the allowed charge.

Copayments are simple to administer and predictable for the patient. They differ from coinsurance, which is a percentage, and from deductibles, which must be satisfied before most benefits begin. Tiered copayments are common in drug plans, with lower amounts for generic drugs and higher amounts for brand-name or specialty drugs.

Plan designers use copayments to influence utilization and to share costs without creating large unexpected bills. Very low copayments may encourage unnecessary visits; very high ones may deter needed care. The amounts appear in the schedule of benefits and are a key element of plan comparison.

• Fixed dollar amount paid by the insured per service
• Common in health and prescription drug plans
• Differs from percentage coinsurance
• Used to share cost and guide utilization