©1998-2021 BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association. BlueCross BlueShield of Tennessee is a Qualified Health Plan issuer in the Health Insurance Marketplace. 1 Cameron Hill Circle, Chattanooga TN. Copay (also known as copayment) The set dollar amount you pay for a covered health care service at the time you receive care or when you pick up a prescription drug. Cost-sharing reduction (CSR) A discount that lowers the amount you have to pay out-of-pocket for deductibles, coinsurance, and copayments. A copayment or copay is a fixed amount for a covered service, paid by a patient to the provider of service before receiving the service. It may be defined in an insurance policy and paid by an insured person each time a medical service is accessed. 2 Put People First: Service‐Minded, Respectful & Embraces Diversity Be Bold & Think Differently: Innovative, Courageous & Solution‐Oriented Do the Right Thing: Safety‐Focused, Integrity & Accountability Jefferson Health recognizes that by providing quality health care to our patients, and education.
What is a copayment?
A copayment is a defined dollar amount a patient pays for medical expenses. With many health insurance plans, a patient pays 100 percent of costs out-of-pocket until they have met their deductible. After meeting the deductible, a patient pays a copayment (often shortened to “copay”).
Do I pay the same copayment for all types of healthcare services?
No. Health insurance plans set different copay amounts for different types of services, such as an emergency room visit vs. an office visit. For prescription drugs, most plans define different copayments for different categories (formulary tiers) of drugs. For example, a plan might have a $10 copay for a generic drug, $25 for a preferred brand-name drug, $50 for a non-preferred brand-name drug, and $100 for a specialty drug.
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Plans may also require a mixture of copayments and coinsurance. For example, you may have a copayment for prescription drugs, but coinsurance for a hospital stay. And, insurance plans sometime “stack” copayments and coinsurance. For example, you might pay a baseline copayment of $100 for a hospital stay plus 20 percent of charges for healthcare services you receive during your stay.
Do copayments vary if I go to an in-network vs. out-of-network provider?
Yes, almost all health insurance plans require the patient to pay more for an out-of-network service. Check your certificate of insurance, certificate of coverage, or summary plan description (SPD) to understand what portion of a given medical expense you will be responsible for paying. Some plans might not cover a service provided by an out-of-network. Others may require the covered individual to pay the difference between charges from an in-network and an out-of-network provider.
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Pyn Copay Abbreviation
copayment
(kō′pā′mənt)n. A specified sum of money that patients covered by a health insurance plan pay for a given type of service, usually at the time the service is rendered.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.
co·pay·ment
, copay (kōpā-mĕnt, kōpā)A fixed or set amount paid for each health care or medical service; the remainder is paid by the health insurance plan. In common parlance, copay is the term used.
See also: coinsurance, cost sharing
Synonym(s): out-of-pocket costs, out-of-pocket expenses.
See also: coinsurance, cost sharing
Synonym(s): out-of-pocket costs, out-of-pocket expenses.
Medical Dictionary for the Health Professions and Nursing © Farlex 2012
co·pay·ment
, copay (kōpā-mĕnt, kōpā)That portion of a dental care charge for which the patient herself, rather than a third party payor (i.e., insurer), is responsible.
Medical Dictionary for the Dental Professions © Farlex 2012
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