What is a copayment?

A copayment (also called a copay) is a type of health insurance cost-sharing requirement in which the insured person pays a fixed amount out-of-pocket for medical services. Copayments are typically made at the time of service, and the amount the insured person pays is usually determined by their health insurance plan. In Virginia, copayments are regulated by the Code of Virginia. In order to make sure that there is a balance between the cost of services and the responsibility of insured individuals for paying for them, Virginia health insurance plans are required to include copayments. Copayment amounts vary from one plan to the next and can range from a few dollars up to a percentage of the total cost of the service. Depending on the policy, copayments may be due at the time of service or may be billed to the insured person after the service is rendered. In some cases, the copayment may be waived if the insured person meets certain financial or medical criteria. Copayments represent one component of a larger health insurance costs-sharing system. Other forms of cost-sharing, such as coinsurance and deductibles, may also be required by Virginia health plans. In all cases, it is important for insured individuals to carefully review their policy in order to understand what their financial responsibilities will be.

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What is a copayment?

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