Co-Payments

Defined

A co-payment is a fixed fee an insured person is expected to pay each time a particular covered medical service is received and can differ by the place of service.

Practice Setting

The Academy supports the application of differential co-payments by practice setting only to incentivize patients to select/maintain a patient-centered medical home as defined by the AAFP.

Multiple Co-Payments

Multiple co-payments may be assessed for separately identified and delivered services. However, patients should not be required to pay more than a single co-payment for a preventive and an acute service provided during a single office visit.

Waivers

When a co-payment is a barrier to medically necessary care, physicians may on a case-by-case basis forgive or waive the co-payment. Reasons for such may include for financial hardship. Physicians should ensure that forgiving or waiving co-payments is consistent with the terms of their agreements with insurers and any applicable law.

(Board Chair October 2006) (2010)