Covered California Certified Enroller Practice Exam

What is a copayment (copay)?

1. A percentage of a claim paid by the insurer

2. A fixed amount paid for a specific service

3. The total annual cost of insurance

4. Payment for out-of-network services only

The correct answer is: A fixed amount paid for a specific service

A copayment, often referred to as a copay, is a predetermined, fixed amount that an individual pays for a particular healthcare service at the time of receiving that service. This amount can vary depending on the type of service received, such as a doctor's visit, a specialist consultation, or a prescription medication. When an insured individual accesses healthcare, the copayment is typically established in the insurance policy and is designed to share the cost of services between the insurer and the insured. In contrast, the other options describe different aspects of insurance and healthcare costs. For instance, a percentage of a claim paid by the insurer refers to coinsurance, and the total annual cost of insurance relates to premiums. Payment for out-of-network services typically involves different terms and conditions, often with higher costs than in-network services. Thus, the definition of a copayment is accurately captured by the description of a fixed amount paid for specific services.