What Is a Copay?
A copay (or copayment) is a fixed amount you pay for a covered healthcare service after you've paid your deductible. For example, you might pay a $25 copay for a primary care visit or $50 for a specialist visit, regardless of the total cost of the service.
What Is Coinsurance?
Coinsurance is a percentage of costs you share with your insurance company after meeting your deductible. For example, if your plan has 20% coinsurance, you pay 20% of the allowed amount for a service and your insurance covers the remaining 80%.
Copay vs. Coinsurance: Key Differences
The main difference is predictability. With a copay, you know exactly what you'll pay upfront. With coinsurance, your cost depends on the total bill — 20% of a $200 visit is $40, but 20% of a $2,000 procedure is $400.
How the Out-of-Pocket Maximum Protects You
Both copays and coinsurance count toward your annual out-of-pocket maximum. Once you hit this limit, your insurance covers 100% of covered services for the rest of the year. For 2026, the ACA out-of-pocket maximum for an individual plan is capped by federal guidelines.
Tips for Managing Cost-Sharing
- Use in-network providers to minimize costs
- Ask for cost estimates before procedures
- Take advantage of free preventive care services
- Consider a plan with lower coinsurance if you expect frequent medical visits
