A deductible is what you pay before the plan starts paying; a copay is a flat fee for a specific service; coinsurance is your percentage share of a cost after the deductible; and the out-of-pocket maximum is the most you’ll pay in a year before the plan covers 100% of covered services.
Cost-Sharing
Deductibles, copays, coinsurance, and out-of-pocket maximums determine how you and your plan split the cost of care. These FAQs explain each term and how they fit together.
What’s the difference between the premium and the total cost of a health plan?
The premium is only what you pay to have coverage. Your total cost also includes the deductible, copays, and coinsurance you pay when you use care, up to the out-of-pocket maximum. A low-premium plan can cost more overall if you use a lot of care.