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Texas Department of Insurance
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August 28, 2023

Do you know the difference between a copay and coinsurance?


copay vs. coinsurance

Twenty five percent of Americans with health insurance recently told a pollster they find terms such as “copay” and “coinsurance” hard to understand.

We get it.

After all, the words sound alike.

And both relate to your paying money out of pocket when you get health care.

But there are differences:

  • You get charged a copay when getting treatment covered by your health plan.
  • Your copay is a fixed amount. It varies based on the service you get. For instance, your plan might charge a $15 copay for a generic prescription drug, $30 to visit your primary care doctor, or $50 to see a specialist.
  • Coinsurance kicks in after you have met your plan’s annual deductible, which is what you pay out of pocket before your plan starts picking up a share of medical expenses.
  • What you pay in coinsurance for a health care service is a percentage of what your plan pays the doctor or medical provider. Example: If your plan’s allowed amount for a treatment is $100, your coinsurance payment of 20% would be $20. Your plan pays the remaining $80.

Learn more