The office visit copay is a set dollar amount (e.g. $15 per visit for a primary care visit) that is typically due at the time of your visit.
- High Deductible Health Plan participants: You will pay the full cost of the visit prior to meeting your deductible. Once your deductible is met, you will pay the office copay amount.
- The office visit copay covers the office visit only, and does not cover any additional services you might receive during your visit (e.g. lab work or X-rays).
- Additional services are subject to your deductible and coinsurance until you reach your out-of-pocket limit.
You will not pay copays for preventive care office visits. Visit Healthcare.gov's Preventive health services page for more information.
Examples of Office Visits Types and Copay Amounts
| Office Visit Type | $15 Primary Care Visit | $25 Specialty Visit |
|---|---|---|
| Family Practice | ✔ | |
| General Practice | ✔ | |
| Internal Medicine | ✔ | |
| Gynecology/OB | ✔ | |
| Midwives (if your plan provides in-network midwives) | ✔ | |
| Nurse Practitioners | ✔ | |
| Physician Assistant | ✔ | |
| Pediatrics | ✔ | |
| Urgent Care | ✔ | |
| Chiropractic | ✔ | |
| Home Health Visit | Subject to deductible and coinsurance | Subject to deductible and coinsurance |
| Palliative Care Visit | ✔ For PCP Only | ✔ For Specialist Only |
| Vision Exam | ✔ | |
| Pre/Postnatal Visits | ✔* For family practice with obstetrics or OB/GYN | ✔* For maternal/fetal specialist |
| Mental Health Visits/Therapy | ✔ | |
| Physical Therapy | ✔ | |
| Occupational Therapy | ✔ | |
| Speech Therapy | ✔ | |
| Other Practitioner | ✔ |
*If all prenatal visits are billed as a package at the end of pregnancy, then your deductible and 10% coinsurance apply. Check with your doctor’s office for more information.