What Are Deductibles, Copayments, and Coinsurance?
We know that medical bills can be confusing—and we’re here to help you make sense of them.
Here’s a simple breakdown of the most common terms you’ll see when using your health insurance:
Deductible
This is the amount you pay out of pocket each year before your insurance starts covering your medical costs.
Example:
If your deductible is $1,500, you’ll pay the first $1,500 of your medical expenses yourself. After that, your insurance kicks in.
Copayment (Copay)
A copay is a fixed amount you pay for a specific service—usually at the time of your visit.
Example:
You might pay a $25 copay when you see a doctor, or a $10 copay when you pick up a prescription. The amount depends on your insurance plan.
Coinsurance
Coinsurance is a percentage of the medical bill that you pay after you’ve met your deductible.
Example:
Let’s say your plan covers 80% of a service and you’re responsible for 20% (this is your coinsurance). If the total cost of a procedure is $200, you would pay $40, and insurance would pay $160—but only after your deductible is met.
Out-of-Pocket Maximum
This is the most you’ll have to pay in a year for covered services. Once you reach this limit, your insurance pays 100% for covered care.
Still Have Questions? We’re Here to Help.
We know every insurance plan is a little different. If you’re unsure about your coverage, deductible, or what a visit might cost, just ask. Our team can guide you through it.