A copay is a fixed dollar amount a member pays for a covered service under their insurance plan, such as $30 for a therapy session. Unlike coinsurance, which is a percentage of the allowed amount, a copay is a flat fee that usually doesn’t change with the cost of the service. Depending on the plan, a copay may apply right away or only after the deductible has been met. Copays often count toward the out-of-pocket maximum but usually not toward the deductible, although plan rules vary.
Copays are most common for in-network care. Many plans don’t apply a copay to out-of-network therapy and use the deductible and coinsurance instead. In that case, a client seeing an out-of-network therapist usually pays the full session fee upfront and may later be reimbursed based on the insurer’s allowed amount. Ask the insurer whether a copay applies to out-of-network mental health visits, rather than assuming the in-network copay applies.