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Cost Sharing

Health plans cover certain services, but a share of the costs still comes out of your own pocket. Your share typically consists of three components: copayments, deductibles and coinsurance.

The copay is a fixed amount you pay for a certain service. It’s usually listed on your insurance card, such as “$15 office.” That means you’d pay $15 towards an office visit with your doc, no matter the total cost. Prescriptions have copays, too. The copays you pay do not count toward your deductible.

What’s a deductible?  This is the set amount you pay for certain services before your benefits kick in. In the example above, in addition to your $15 copay-- if the whole visit costs $100-- $85 of that would count toward your deductible.

Once you’ve met your deductible, you may still have to pay a percentage of the bill for the services you receive. That’s called coinsurance. Say you’ve met your deductible, have a $15 copay and coinsurance of 20 percent. On a $500 bill, you’ll owe $15 plus $100 (20% of $500) for a total of $115.

The good news? In this example, your health plan would pay the balance of $385 for an important service to help you get or stay well.

For More Information:

Want to learn more about how insurance works?  Check out our Health Insurance Basics.