Health insurance plans use several terms to explain what you pay for care. Understanding them helps you compare plans beyond the monthly premium.

What is a deductible?

A deductible is the amount you pay for certain covered services before the plan begins paying its share. Some services may be covered before you meet the deductible, depending on plan rules.

What is a copay?

A copay is a fixed amount you pay for a covered service, such as a doctor visit or prescription. The amount may depend on the service and plan.

What is coinsurance?

Coinsurance is a percentage of the allowed cost for a covered service. For example, if a plan says you pay a percentage after meeting the deductible, your share depends on the covered amount and the plan’s terms.

Why the difference matters

Two plans with similar premiums can have very different costs when you need care. Estimate your likely visits, prescriptions, tests, and potential unexpected expenses.

Check the out-of-pocket maximum

Marketplace plans have an annual limit on what you pay for covered essential health benefits in-network, subject to the plan’s rules and applicable exceptions. Premiums and non-covered services generally do not count toward that limit.

Important: Plan terms vary. Read the Summary of Benefits and Coverage and confirm details with the insurer.