Copay vs. Coinsurance: What's the Difference?

Copays and coinsurance are both ways you share costs with your insurer, but they work differently and often apply to different situations on the same plan.

A copay is a fixed dollar amount for a specific service — like $30 for a primary care visit or $50 for a specialist — regardless of what that visit actually costs. Copays are predictable and simple: you know the number before you go.

Coinsurance is a percentage split of the cost, applied after you've met your deductible. With 80/20 coinsurance, your insurer pays 80% of the (negotiated, in-network) allowed amount and you pay 20% — until you hit your out-of-pocket maximum. Unlike a copay, the dollar amount you owe varies depending on how expensive the service actually was.

Where they typically apply: many plans use copays for routine, predictable visits (primary care, urgent care, prescriptions) and coinsurance for larger, less predictable costs (hospital stays, surgery, specialist procedures). Some plans use only coinsurance for everything after the deductible — always check your specific plan's summary of benefits.