A type of cost sharing whereby insured or covered persons pay a specified flat amount per unit of service or unit of time (eg. $2 per visit, 810 per inpatient hospital day), their insurer paying the rest of the cost. The copayment is incurred at the time the service is used. The amount paid does not vary with the cost of the service (unlike coinsurance, which is payment of some percentage of the cost).
A fixed amount of money paid by a health care plan enrollee (beneficiary) at the time of service. For example, the enrollee may pay a $10 “copay” at every physician office visit, and $5 for each drug prescription filled. The health plan pays the remainder of the charge directly to the provider. This is a method of cost-sharing between the enrollee and the plan, and serves as an incentive for the enrollee to use health care resources wisely. An enrollee might be offered a lower price benefit package in return for a higher copayment.
The fee insured persons must pay, in addition to their health insurance premiums and deductibles, for specific medical services such as emergency department visits, appointments with primary care providers, laboratory studies, prescriptions, or x-ray examination.
The amount of a person’s medical expenses not paid by the insurance company, for which the individual is responsible.
The out-of-pocket expenses incurred by an insured individual for healthcare services are referred to as the individual’s financial responsibility.