What Is a Copay?
A copay (short for copayment) is a fixed amount you pay out of pocket each time you receive a covered medical service. Unlike coinsurance, which is a percentage, a copay is a set dollar amount — $35 for a primary care visit, $65 for a specialist, $15 for a generic prescription. You know exactly what you'll pay before you walk in.
Common Copay Amounts (2026)
- Primary care visit: $25-$50
- Specialist visit: $50-$100
- Urgent care: $35-$75
- Emergency room: $250-$500 (often waived if admitted)
- Generic prescription: $10-$20
- Brand-name prescription: $30-$70
These amounts apply to both ACA marketplace plans and private plans from carriers like Blue Cross, Cigna, Aetna, and UnitedHealthcare.
Copay vs. Coinsurance: What's the Difference?
A copay is a fixed amount ($35 for a visit). Coinsurance is a percentage (you pay 20%, insurance pays 80%). Some plans use copays for routine visits and coinsurance for larger services like hospital stays. Gold and Platinum plans tend to use more copays; Bronze plans tend to use more coinsurance.
Pro tip: If you see a doctor regularly, a plan with copays (Gold or Silver) is more predictable than one with coinsurance. You know every visit is $35 — no surprises. Plans with coinsurance can vary widely depending on what the provider charges.
Do Copays Count Toward Your Deductible?
It depends on the plan. Many Silver and Gold plans offer copays before you meet your deductible — meaning you pay $35 for a doctor visit from day one. On Bronze plans, you typically pay full price until you hit your deductible. All copays count toward your out-of-pocket maximum.
Related Terms
Last updated: March 30, 2026.
