Premium vs Deductible vs Copay vs Coinsurance (Plain English)
Quick answer: The premium is your monthly payment. The deductible, copay, and coinsurance are what you pay when you use care.
What is a premium?
Your premium is the fixed amount you pay each month to have coverage, whether or not you see a doctor.
What is a deductible?
The deductible is the amount you pay for covered care before your plan starts sharing costs. If your deductible is $2,000, you pay the first $2,000 of many services yourself.
What is a copay?
A copay is a flat fee for a specific service, like $30 for a doctor visit or $10 for a generic prescription.
What is coinsurance?
Coinsurance is a percentage you pay after you meet your deductible. With 20% coinsurance, the plan pays 80% and you pay 20%.
For example, with a $1,000 deductible and 20% coinsurance on a $3,000 procedure, you pay the first $1,000. On the remaining $2,000, you pay 20%, which is $400. Your total is $1,400, plus your monthly premiums.
What is an out-of-pocket maximum?
This is the most you would pay in a year for covered care. After that, the plan pays the rest.
Quick Questions
Is a low deductible always better?
Not always. Plans with low deductibles usually have higher premiums.
Do copays count toward my deductible?
It depends on the plan. We can check this for you.
Do I pay a deductible for every service?
No. Many plans cover things like preventive visits before the deductible.
Which costs do premiums count toward?
Premiums do not count toward your deductible or out-of-pocket maximum.
How do I pick the right mix?
Think about how often you use care and how much risk you're comfortable with. We're happy to help you compare.
Want help choosing the right plan?
Book a free consultation or give us a call. We'll walk through your options in plain English, with no pressure.