A copay is a flat dollar amount you pay for a specific service. Coinsurance is a percentage of the cost you pay after you’ve met your deductible. Both are forms of “cost-sharing” — your part of the bill.
A simple example
Copay: your plan charges $30 to see your primary-care doctor. You hand over $30 at the desk; the plan handles the rest of the negotiated cost for that visit.
Coinsurance: after meeting your deductible, your plan pays 80% and you pay 20%. On a $1,000 in-network service, you owe $200 and the plan pays $800.
Why it matters to you
Copays are predictable, which makes budgeting easier. Coinsurance is a percentage, so on big bills like surgery your share can grow fast — until you reach your out-of-pocket maximum, which caps it.
Good to know
- For some services a copay can apply on top of coinsurance — check what each visit or prescription tier actually costs.
- Copays sometimes apply before you’ve met your deductible; coinsurance generally applies after.
- Prescription drugs are often grouped in tiers, each with a different copay or coinsurance.
Definitions: Copayment · Coinsurance. See also Deductible and Out-of-pocket maximum.
Educational use only. This content is general health and cost information — not medical advice, diagnosis, or treatment, and not financial, legal, or insurance-coverage advice. Specifics vary by plan and situation. Talk with a qualified clinician about your care and verify coverage with your insurer or provider. In an emergency, call 911.