| Copay | Coinsurance | |
|---|---|---|
| How it is set | Flat dollar amount | Percentage of the allowed amount |
| Example | $30 per visit | 20% of the bill |
| Usually applies | Often before or without the deductible for office visits | After the deductible |
| Predictable? | Yes, you know the price | Depends on the bill |
| Counts toward the maximum? | Yes (covered in-network) | Yes (covered in-network) |
Worked example: one year of care under two plans
Services (allowed amounts): 3 primary care visits at $150, 2 specialist visits at $300 and one MRI at $1,200. Total allowed: $2,250.
| Plan A: copays + $500 deductible, 20% | Plan B: $1,500 deductible, 20% on everything | |
|---|---|---|
| Office visits | $210 in copays (3 × $30, 2 × $60) | Counted toward the deductible |
| MRI | $500 deductible + 20% of $700 = $640 | Counted toward the deductible |
| Total you pay for care | $850 | $1,650 |
Plan A’s copays make routine visits predictable; plan B charges you the full allowed price until the deductible is met. Plan B usually has the lower premium. Totals above leave out premiums, so compare the whole yearly cost with the HSA vs PPO calculator, which accepts an annual copay amount for the PPO.
Things to check
- Some copays apply before the deductible and some only after; the plan summary says which.
- Emergency room and hospital stays often use a copay plus coinsurance.
- HSA-eligible plans generally cannot use copays for non-preventive care before the deductible is met.
Related: deductible vs maximum · what counts toward the maximum · plan costs hub.
This is general information, not tax or insurance advice. Confirm details with your plan documents, the IRS and a qualified professional.
General education, not insurance, tax or legal advice. Figures from IRS and HHS publications; confirm with your plan documents.