Lesson
Premiums, deductibles, and copays
- Published:
- October 12, 2026
- Review status:
- Needs verification — carefully written, not yet checked by a qualified professional
AThe super simple explanation
The is what you pay to have insurance, usually monthly.
The is how much you pay for covered care before your plan starts sharing costs.
A is a fixed amount you pay for a visit or prescription.
BWhy does this even matter?
- It helps you pick a plan that fits your budget and health needs.
- It helps you predict what a doctor visit will cost.
- It explains why you might get a bill even though you have insurance.
COkay, how does it work?
Try it
Premiums, deductibles, coinsurance & out-of-pocket max
Plan A (lower premium)
$200/mo premium · $3,000 deductible · 30% coinsurance · $7,000 out-of-pocket max
- Premiums for the year: $2,400
- Deductible part: $2,000
- Coinsurance part: $0
- Insurance pays: $0
- Your total for the year: $4,400
Plan B (higher premium)
$380/mo premium · $750 deductible · 20% coinsurance · $4,000 out-of-pocket max
- Premiums for the year: $4,560
- Deductible part: $750
- Coinsurance part: $250
- Insurance pays: $1,000
- Your total for the year: $5,560
Fictional plans. Simplified: assumes all care is covered and in-network, ignores copays and services covered before the deductible. Real plans vary — check the plan's Summary of Benefits and Coverage.
DShow me an example
A big bill (illustrative)
Plan: $1,500 deductible, 20% coinsurance, $5,000 out-of-pocket max.
You have a $6,500 covered procedure.
You pay the first $1,500. Of the remaining $5,000, you pay 20% ($1,000). Total: $2,500.
Illustrative example with made-up people and numbers — not current rates or rules.
EWords you should know
- Premium
- The regular amount you pay to keep an insurance plan active, whether or not you use it.
- Deductible
- The amount you pay for covered care each year before your insurance starts sharing the cost.
- Copay
- A set amount you pay for a covered health service, like a doctor visit.
- Coinsurance
- The percentage of a medical bill you pay after you've met your deductible.
- Out-of-pocket maximum
- The most you'd pay for covered in-network care in a plan year; after that, the plan pays 100% of covered costs.
FCommon mistakes
- Picking a plan only by the lowest premium.
- Thinking premiums count toward the deductible. They don't.
- Forgetting to check whether a provider is in-network.
GQuestions people are too embarrassed to ask
HQuiz me
Totally optional. Nobody's grading you.
IWhat next?
- 1.Find your plan's Summary of Benefits and Coverage and locate these numbers.
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