With a copay you pay the same fixed amount at every physical therapy visit, often from the first visit. With coinsurance you pay a percentage of the plan’s allowed amount for each visit, usually after the deductible is met, so the price changes from visit to visit. Original Medicare uses coinsurance: 20 percent of the approved amount after the Part B deductible. Under either design, your spending stops once you reach the plan’s out-of-pocket maximum.
Last reviewed By the Monon Therapy Collective editorial team
What is the plain difference between a copay and coinsurance?
A copay is a set fee, such as the amount printed on your insurance card, paid every time you get a covered service. Coinsurance is a percentage: you pay that share of what the plan allows for the service, and the plan pays the rest. Your Summary of Benefits and Coverage shows which one applies to rehabilitation services.
The practical difference is predictability. A copay lets you know the cost of a visit before you walk in. Coinsurance depends on what was billed that day and what your plan allows for it, so you often learn the exact amount only when the explanation of benefits arrives.
Neither design changes the care you receive. The therapist chooses treatment based on your examination and goals, not on whether you pay a copay or coinsurance, and the same plan of care can cost very different amounts under two different plans. If cost is shaping your decisions, say so early, because a plan can often be built with fewer, well-spaced visits and a stronger home exercise program.
Why does a coinsurance therapy visit cost a different amount each time?
Because each visit is billed by what happened in it. The first evaluation uses its own code, a re-evaluation another, and treatment visits are billed in 15-minute units of services such as therapeutic exercise or manual therapy. A visit with more billable time or different services carries a different allowed amount, so your percentage share moves too.
This surprises many people, but it is normal. If you want a stable estimate, ask the therapist’s office what a typical follow-up visit is billed as and what your plan allows for it. The cost of physical therapy with insurance page walks through reading those numbers.
How do the deductible and coinsurance work together for therapy?
On most coinsurance plans, the deductible comes first. Until it is met you pay the full allowed amount for each visit; after that you pay only your percentage. Copays often work differently, applying from the first visit without waiting for the deductible, though some plans say “copay after deductible”.
Original Medicare is the cleanest example of coinsurance. In 2026 you pay the $283 Part B deductible once for the year, then 20 percent of the Medicare-approved amount for each therapy visit. Most standardized Medigap plans pay some or all of that 20 percent, which the Medigap physical therapy page explains.
Medicare Advantage plans often work the other way round, charging a flat copay for each outpatient therapy visit instead of a percentage, sometimes with prior authorization required. If you are choosing between Original Medicare with a Medigap policy and a Medicare Advantage plan, compare how each would handle a few months of therapy, not just a single visit.
Which costs more over a full course of physical therapy?
It depends on the size of the copay, the coinsurance percentage, the allowed amount and how many visits you need, so neither is always cheaper. Coinsurance plans can be cheap per visit once the deductible is met and the percentage is low; copay plans can add up if the fixed fee is high and the plan runs for months.
To compare, multiply. For a copay plan, multiply the copay by the visits you expect. For a coinsurance plan, ask for the allowed amount for a typical visit, apply your percentage, then multiply, and add any deductible still owed. Whatever the design, everything stops at the out-of-pocket maximum; for 2026 marketplace plans the in-network limit is $10,600 for one person and $21,200 for a family.
Remember that premiums are a separate cost. A plan with a low therapy copay may carry a higher monthly premium, so the cheapest plan for a year of rehab is not always the one with the smallest per-visit fee. That comparison matters most during open enrollment, if you already know surgery or a long course of rehab is coming.
What should I ask before my first appointment in Carmel?
A few targeted questions give you a realistic picture before anything is booked. Before matching you, the matching team asks about your plan and proposes a therapist in the network whose office works with it where possible; the therapist’s office then verifies benefits, and these are the questions worth putting to it.
- Is my therapy cost a copay or coinsurance, and does the deductible apply first?
- How much of my deductible and out-of-pocket maximum have I met this year?
- What does my plan allow for an evaluation and a typical follow-up visit?
- Is there a yearly visit limit or a prior authorization requirement?
- What is the self-pay rate if I continue after coverage ends?
Related questions
Do I pay a physical therapy copay at the visit or later?
Copays are usually collected at the visit. Coinsurance is often billed after the claim is processed, because the exact amount is not known until then.
Does my copay count toward my out-of-pocket maximum?
Yes. Copays, coinsurance and deductible payments for covered in-network care all count toward the out-of-pocket maximum. Premiums do not.
Can I have both a copay and coinsurance for therapy?
Some plans charge a copay for the visit plus coinsurance for certain services, but that is uncommon for outpatient therapy. Your benefits summary will say if it applies.
Is coinsurance calculated on the price the practice charges?
No. It is calculated on your plan’s allowed amount, which is usually lower than the full charge for in-network care.
What if my therapist is out of network?
Out-of-network care often has a higher coinsurance, a separate deductible and possible balance billing. Our out-of-network reimbursement page explains how claims for those visits work.
Keep reading
- Is physical therapy covered before I meet my deductible?
- Does physical therapy count as a specialist visit?
- How much does physical therapy cost with Medicare?
- Physical therapy cost and insurance in Carmel
- Medicare physical therapy coverage
- Start the physical therapy questionnaire
Sources
This page is general education, not medical advice. A physical therapist can only advise on your situation after an examination.
