Deductible, copay and coinsurance in plain English
Three words that decide most of what you pay.
Deductible: the amount you pay yourself before your plan starts sharing costs.
Copay: a fixed amount for a particular visit or service, such as $30 to see a doctor.
Coinsurance: a percentage of the allowed amount that you pay after the deductible, such as 20%.
Out-of-pocket maximum: the most you would pay in a plan year for covered services. Your own plan documents have the exact figures.
A simple made-up example
Say a visit has an allowed amount of $200, you have already met your deductible, and your plan has 20% coinsurance. Your share would be $40 and the plan would pay $160. This example is fictional — your plan's numbers may be different.
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Important: The Medical Bill Detective provides informational assistance based on the documents you provide. It does not provide medical, legal, insurance, or financial advice and does not determine whether a bill is legally valid, fraudulent, or incorrect. Potential discrepancies should be verified with your healthcare provider and/or insurance company.