What's the difference in copays vs deductibles?

Question

Leslie Kaz · Accepted Answer

A deductible is the amount you pay first each year before your plan starts helping with costs. For example, if your deductible is $200, you pay the first $200 of covered services yourself.

A copay is a set amount you pay for a service or prescription after your deductible (if any) is met. For example, you might pay $20 each time you see your doctor, no matter the visit cost.

Tracy Davis · Answer

A copay is what you are going to be responsible when you utilize a medical procedure or even when you pick up your medications immediately. A deductible on the other hand is what you will pay first before the insurance company will pay. So, if you are on a plan that has a $300 deductible for medications (for all tiers) then you would pay the first $300 towards any of your medications before the plan would pick up any of the cost. Once the deductible is met then typically there is a set copayment or coinsurance that you are responsible after that point. A deductible is not to be confused with a maximum out of pocket (believe me it commonly is). The maximum out of pocket is the maximum amount you can pay within a year. Once your maximum is hit then the insurance company is to pay the copayments and coinsurance until the end of the calendar year. This resets at the end of each year.

Answered by Tracy Davis on August 11, 2025

Broker Licensed in IN, CO, FL & KY, NM, OH & TN

Answered by Tracy Davis Medicare Insurance Agent

Brenda Trejos · Answer

Yes, its confusing!  Basically, a deductible is a higher amount (usually $500 on the low end and up to $5000 or more) that you need to meet before your Insurance Company starts paying for your medical costs.    
A copay on the other hand is usually a set amount (usually around $10 and up to $500) that you pay for a certain appointment or procedure.   For ex: a Primary Care appointment might cost a $20 copay, while with your deductible you might pay over $100 for that same appointment.    That said, deductible plans usually have a lower monthly premium and Plans with copays are usually more expensive per month.  
Until recently, most Advantage Plans did not have a deductible, only copays.  Because of the Inflation Reduction Act, more Advantage Plans are now adding deductibles to their Plans.

Vernon Jones · Answer

A copays is that you be are to pay your doctors or providers at a doctor visit and also for your medication at a pharmacy based on your medical plan. And a deductible is what you as the insured is to pay prior to your plan paying their part of the cost.

Answered by Vernon Jones on August 12, 2025

Broker Licensed in NC & SC

Answered by Vernon Jones Medicare Insurance Agent

Daniel Underwood · Answer

A deductible is the amount you must pay out of pocket each year before your insurance starts covering costs. A copay is a set dollar amount you pay each time you get a service, like a doctor visit or prescription, even after your deductible is met.

Answered by Daniel Underwood on August 11, 2025

Broker Licensed in LA

Answered by Daniel Underwood Medicare Insurance Agent

Patricia Graham · Answer

Deductibles are annual except for hospital confinement, which is progressive. Co-pays are as you use the benefits.

Parris Brady · Answer

Deductible is typically a large dollar amount that you will need to pay before the insurance starts to pay. Copay is a fixed dollar amount that you will need to pay every time you receive services.

Kelli Holt · Answer

A copay is a set amount you pay for a specific procedure/service at the time you receive it.  For example you may have a $0 copay for a visit to your primary care provider but a $40 visit to a specialist. 
A deductible is the amount you pay out of pocket first, before your insurance starts to pay.  For example, if you have a $300 deductible, you must pay the first $300 in service fees before the plan begins to share the cost.

What's the difference in copays vs deductibles?

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What's the difference in copays vs deductibles?

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