Copay vs Coinsurance: What Is the Difference?

Fixed dollars vs percentages

A copay is a flat fee for a service — for example $40 for a specialist visit. Coinsurance is a percentage of the allowed amount after you meet your deductible — for example 20% of a hospital bill.

Plans often use both: copays for routine visits and coinsurance for larger services. Knowing which applies to the care you use is more useful than memorizing every plan term.

Which is better for you

Copays are easier to budget because you know the amount in advance. Coinsurance can be cheaper for small bills but expensive for big ones until you hit the out-of-pocket maximum.

If you expect hospital care or imaging, model coinsurance against the out-of-pocket maximum. If you mainly use primary care, low copays may matter more.

Frequently asked questions

Do copays apply before the deductible?

Often yes for primary care and specialist visits, but it depends on the plan. Read the Summary of Benefits for your specific services.

Do copays count toward the out-of-pocket maximum?

Usually yes for covered in-network care. Confirm in the plan documents.