Deductible, copay, and coinsurance: what you actually pay
Published May 21, 2026
These four words determine your real cost of care. Once you see how they fit together, comparing plans gets much easier.
Say your plan has a $2,000 deductible, 20% coinsurance, and a $25 copay for office visits.
A routine visit may just cost the $25 copay. But a $3,000 procedure works differently: you pay the first $2,000 (deductible), then 20% of the remaining $1,000 ($200 coinsurance), so $2,200 total — unless that pushes you past your out-of-pocket maximum, after which the plan pays everything.
A low premium with a high deductible can cost more than a higher-premium plan if you use a lot of care. Estimate your typical year before you choose.
Frequently asked questions
＋ Do copays count toward my deductible?
It depends on the plan. Sometimes copays count toward the out-of-pocket maximum but not the deductible. Read the plan summary.
＋ What counts toward my out-of-pocket maximum?
Generally deductibles, copays, and coinsurance for covered in-network care count. Premiums do not.
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Educational content only — not legal, financial, or insurance advice. Requirements and pricing vary by state.