Copayment (Copay)

A fixed dollar amount the insured pays each time a covered service, such as an office visit or prescription, is received — A copayment is a flat, fixed dollar amount the insured pays at the point of service, for example, $30 per office visit or $10 per prescription. It is a defined-dollar cost-share rather than a percentage of the bill, which is what distinguishes it from coinsurance. Copayments and coinsurance both reduce the insurer's payout and discourage overuse, but they are calculated differently: one is a stated fee per service, the other a proportional share of expense. Recognizing the fixed-dollar feature of a copay is a standard contract-provision question for medical expense plans (AH-III.A.1d).

National insurance concept

Medicare Part A — Medicare covers hospice care under Part A for beneficiaries with a terminal illness — certified as having a life expectancy of six months or less — who elect the hospice benefit. The benefit provides palliative and supportive care focused on comfort rather than cure: nursing services, medical social services, counseling, hospice aides, and pain management, with very low cost-sharing and little or no copayment for most services. Hospice is one of the Part A benefits enumerated in the senior health products objectives alongside inpatient care, home health, and skilled nursing facility care.

National insurance concept