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In insurance, a fee that a policyholder must pay for certain covered items for which the insurance company otherwise pays. For example, a check-up with a doctor may cost the policyholder a copayment of $25, with the insurance company paying for the remainder of the cost due. A copayment is also called a co-pay and should not be confused with a deductible. It exists to discourage policyholders from abusing the insurance policy.


If you have a managed-care health insurance plan, your copayment is the fixed amount you pay -- often $10 to $25 -- for each in-network doctor's office visit or approved medical treatment

In some plans, the copayment to see a specialist to whom you're referred is higher than the copayment to visit your primary care physician. Some plans may not require copayments for annual physicals and certain diagnostic tests.

If you see an out-of-network provider, you are likely to be responsible for a percentage of the approved charge, called coinsurance, plus any amount above the approved charge.

References in periodicals archive ?
This last paper is most similar to this study in which we examine changes in medication adherence associated with a copayment increase in patients with lower and higher comorbidity burdens.
In contrast to current Medicare policy the Medicare Payment Advisory Commission has issued a new recommendation that seniors be charged copayments for home health care visits.
Gerdes said, because most patients can no more afford the $30 copayment than the $50 one.
For a total of 2,830 employees, copayments for statins were eliminated and the co-payment for clopidogrel was significantly reduced.
Research finds that even modest health insurance copayments discourage older women from getting mammograms.
LOUIS -- Offering consumers the incentive of waiving patient prescription copayments for a limited period of time is effective in promoting greater use of generic medications, according to a report by pharmacy benefits manager Express Scripts Inc.
The results were different for the question about whether the women in the sample believed that the copayment had affected others in the institution.
As insurance costs go up, employers cut back--sometimes reducing coverage, reducing financial support, or increasing deductibles and copayments.
Federal law allows states to require beneficiary contributions, such as premiums and cost sharing (coinsurance, copayments, and deductibles), for at least some Medicaid and SCHIP beneficiaries.
But Bernard pointed out to the man that, per pill, Claritin now costs less than many people's copayment for the prescription drug.
VA's prescription drug copayment, however, increased from S2 to $7 for a 30-day supply.
Actuarial data show a $5 increase in an office visit copayment (from $5 to $10), for example, can reduce the number of office visits by 25% to 30%.