What's the difference in copays vs deductibles?

Question

Brenda Trejos · Accepted 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.

Steve and Sue Brauer · Answer

Hey, thanks for watching. I'm Steve, and my wife Sue is off today. I am the other half of the husband and wife medical team. So the question today is, what's the difference between copays versus deductibles? I get that question a lot. A deductible is something that you typically have to satisfy every calendar year. Once that deductible is satisfied, then you go into one or two things. You either go into coinsurance or you go into a copay.

The coinsurance means that you're responsible for a certain percentage of the rest of the cost of that service. A copay is when you go in. Like with my plan, I go to the specialist, I pay $8. That's a copay. If I had a deductible, I would have to satisfy that deductible or pay towards that deductible first, and then it would either turn into a straight copay where I'd pay my $10 or $15 or whatever, or it would turn into coinsurance, which means I would pay a certain percentage of the rest of that cost. Kind of confusing, but it makes sense when you break it down.

William Lawler · Answer

This answer is provided in a video format. Watch the agent's video response here: https://medicareagentshub.com/questions/whats-the-difference-in-copays-vs-deductibles#william-lawler

Ray McCauley · Answer

copay is a dollar amount you pay for a specific service. a dr visit copay may be a set 5 dollars. a deductible is the dollar amount you must pay out of pocket before services are covered by the plan in a calendar year

Answered by Ray McCauley on May 26, 2026

Broker Licensed in CA, AZ, FL & ID, NV, SC & TN

Answered by Ray McCauley Medicare Insurance Agent

Justin Doherty · Answer

Deductibles must be paid before your plan will pay for certain services. During this stage, you pay 100% of the allowed amount.
Copays are the amount you pay per service in addition to the amount paid by the plan.

Dutch VanHoesen · Answer

As with any insurance, a deductible is what you pay before the plan kicks in. A copay is a standard fee for a procedure, a doctor visit for example.

Adam Ashby · Answer

That is a great question in regard to the difference between a copay and a deductible. A deductible is the amount you are responsible for prior to insurance starting to pay a portion of the coverage. There are a lot of areas where you can find deductible depending on the plan you choose. For example, you may have a prescription deductible, especially for Tier 3, 4 and 5 drugs. You may have a Medical deductible - you see this generally with a MediGap plan, for example a Plan G has a Part B deductible before it takes over and pay expense. A copay is a portion you pay when insurance is involved. With the example of prescriptions, you may have a $5 copay for Tier 2 drugs, meaning when you go to pick up that prescription, you know what the cost will be - it is a standard $5. On the other hand, a Medicare Advantage plan will often have a copay for services that you receive. Your Primary Doctor may be a $0 copay but a specialist is a $35 copay per visit. These are all things you want your Medicare Broker to review with you so you can understand clearly the plans you are selecting to protect yourself.

Answered by Adam Ashby on April 27, 2026

Broker Licensed in CO, GA, IL & 6 other states

Answered by Adam Ashby Medicare Insurance Agent

Ruben Trejo · Answer

A copay is just a set fee you pay at the doctor or pharmacy. A deductible is the amount you’ve got to pay first each year before your insurance really kicks in.

Nadia Ponce Simbron · Answer

A copay is a fixed fee you pay at the time you receive a specific service and a deductible is a set annual amount you pay out-of-pocket for covered medical services before your insurance kicks in.

Leslie Kaz · 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.

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

Gus Karigan · Answer

💰 Deductible

The amount you pay first before your insurance begins to share costs.

Example: If your deductible is $200, you pay the first $200 of covered expenses yourself.

💳 Copay (Copayment)

A set dollar amount you pay each time you get a service, like seeing your doctor or filling a prescription.

Example: You might pay $20 for each doctor visit, regardless of the total bill.

⚖️ Coinsurance

This is a percentage of the cost you pay after meeting your deductible.

Example: If your plan has 20% coinsurance, and your doctor visit costs $100, you pay $20 and insurance pays $80.

✅ In short:

Deductible = what you pay up front before coverage kicks in.

Copay = a fixed fee you pay each time you use a service.

Coinsurance = your share of the bill (a percentage) after the deductible.

Lea Vollmer · Answer

A co-pay is usually a payment for a specialist visit or some kind of service you get. Whereas the deductible is something you have to pay in full before you start making only the copayments.

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, AL, CO & 6 other states

Answered by Tracy Davis Medicare Insurance Agent

Kathy Olejniczak · Answer

Deductibles are amount ms you pay before benefits start. A copay is a specific amount paid for a specific service

Gwendolyn Brown · Answer

Copays will be requested once you arrive at your providers office for your appointment. This will be paid prior to the visit. It will be a set dollar amount like $10/$25/$50/$100, for example.

Deductibles are an out-of-pocket amount that you may, or may not, meet for the medical services you received and were billed for throughout the year (annually). This amount is set for each plan by the carrier each year. If you meet the deductible, the plan normally will cover the out-of-pocket cost totally, unless there is a co-insurance on the plan. Which I have not seen in Medicare plans.

Fred Manas · Answer

A deductible is the amount you pay for healthcare services before your insurance starts to cover costs, while a copay is a fixed amount you pay at the time of service, even after your deductible is met. Essentially, the deductible is a threshold you need to cross, and copays are the fixed fees you pay on top of that.

Answered by Fred Manas on August 13, 2025

Agent Licensed in NY, CT, DC & 7 other states

Answered by Fred Manas Medicare Insurance Agent

Mary Brown · Answer

A copay is a small set fee you pay per visit or prescription.
A deductible is the yearly amount you pay before insurance starts helping.

Mark Boone · Answer

A copay is a fixed amount you pay for a specific service (like a doctor's visit) at the time of service. A deductible is the amount you pay for covered healthcare services before your insurance plan starts to pay its share. A copay is the amount you pay and your insurance pays the remainder. A deductible is the amount you pay for services before your insurance pays anything. Copays are what you will pay each time you have a specific service performed. A deductible is what you will pay until you exceed that amount and then you probably won't have any other payments due for the remainder of the year

Answered by Mark Boone on August 25, 2025

Agent Licensed in MN, FL, MI & NC, OH, SC & VA

Answered by Mark Boone Medicare Insurance Agent

Jennifer Kalbach · Answer

Co Pays are are a set amount of money, fixed fee, that is attached to service covered services while a deductible is a set amount of money you pay out of pocket for covered services per plan year which is before your insurance will start sharing in the costs. Co pays do not always count toward your deductible.

Answered by Jennifer Kalbach on December 9, 2025

Agent Licensed in KY

Answered by Jennifer Kalbach Medicare Insurance Agent

Julie Thompson · Answer

A deductible is your portion to pay before the plan will pay and once its be paid for the year its done. Example $257 deductible for Part B means you pay that before the plan pays towards your doctor services. Once the deductible has been met your are done for the year. A co-pay is an amount you pay each time you go in for services unlike a deductible it generally is paid each time.

Answered by Julie Thompson on October 25, 2025

Agent Licensed in CA, AZ, KY, NV & TN

Answered by Julie Thompson Medicare Insurance Agent

Patricia Graham · Answer

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

Chauncey Bragg · Answer

Copay is a set amount that you pay per visit or when you pick-up your medication. Deductibles is what you have to meet (pay) before your insurance starts to pay for covered medical services. They can be separate or they can be combined.

Answered by Chauncey Bragg on October 10, 2025

Broker Licensed in OH

Answered by Chauncey Bragg 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

Anthony Albano · Answer

A deductible must be met before coverage begins.
A co-pay is a predictable amount for a service. Good example would be a doctor co-pay of $20. That’s a preset amount.

LaShonda Smith · Answer

A copay is a fixed, out-of-pocket fee you pay for a specific service, like a doctor's visit or prescription, while a deductible is the total amount you pay for covered medical services each year before your insurance plan starts to pay its share. Think of the deductible as a larger annual threshold, and the copay as a smaller, per-service fee you often pay along the way.

Answered by LaShonda Smith on November 4, 2025

Agent Licensed in FL, AK, AL & 21 other states

Answered by LaShonda Smith Medicare Insurance Agent

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.

Rebecca Loucks · Answer

This is straight from the 2026 Medicare and You book: 

Copayment
 An amount you may be required to pay as your share of the cost for benefits 
after you pay any deductibles. A copayment is a fixed amount, like $30.
Deductible
 The amount you must pay for health care or prescriptions before Original 
Medicare, your Medicare Advantage Plan, your Medicare drug plan, or your 
other insurance begins to pay.

Ciriaco Gelera · Answer

Both are "out-of-pocket" costs you pay for healthcare, but they happen at different times and for different reasons. The Copay is A Fixed Fee per Visit while The Deductible is Your "Entry Fee" for the Year.

Answered by Ciriaco Gelera on January 3, 2026

Broker Licensed in NJ, CA, FL & NY

Answered by Ciriaco Gelera Medicare Insurance Agent

Artreanua Carr · Answer

A co-pay is a fixed amount paid for a specific healthcare service, while coinsurance is a percentage of the cost of service

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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