Deductible vs. Copay vs. Coinsurance
By Laurence Paolino, RN
These three terms show up on almost every health plan. Here is what each one generally means.
Deductible
The amount you pay for covered services before your plan begins to share costs. For example, with a $1,500 deductible, you generally pay the first $1,500 of covered care yourself.
Copay
A fixed amount you pay for a specific service, such as $30 for a doctor visit or $10 for a prescription. Some copays apply before the deductible is met; others apply after.
Coinsurance
A percentage of the cost you share after meeting your deductible. With 20% coinsurance, you pay 20% of a covered bill and the plan pays 80%.
Out-of-pocket maximum
Many plans have a yearly limit on what you pay for covered services. Once you reach it, the plan generally pays 100% of covered costs for the rest of the year.
