Copays vs. Coinsurance: The Simple Difference
Health insurance can become confusing very quickly.
You may pay a monthly premium to keep your coverage, a deductible before your plan starts sharing certain costs, a copay when you visit a doctor, and coinsurance for other medical services.
Two terms cause particular confusion:
Copay and coinsurance.
The simplest difference is:
A copay is usually a fixed dollar amount.
Coinsurance is a percentage of the allowed cost of a covered service.
HealthCare.gov defines a copayment as a fixed amount you pay for a covered health care service, while coinsurance is the percentage of the cost of a covered service that you pay.
For example:
Copay: $30 doctor visit
versus:
Coinsurance: 20% of the plan’s allowed amount.
That difference can significantly affect how predictable your medical expenses are.
Copay vs. Coinsurance at a Glance
| Feature | Copay | Coinsurance |
|---|---|---|
| How you pay | Fixed dollar amount | Percentage |
| Example | $30 | 20% |
| Predictability | Usually easier to predict | Depends on allowed cost |
| May apply before deductible? | Sometimes, depending on plan | Commonly after deductible |
| Common uses | Office visits, urgent care, prescriptions | Hospital care, imaging, surgery, specialty services |
| Counts toward out-of-pocket maximum? | Generally yes for covered in-network care | Generally yes for covered in-network care |
| Same amount for every service? | No | No |
| Can plans use both? | Yes | Yes |
Your actual policy controls.
A health plan can use:
copays for some services
and:
coinsurance for others.
What Is a Copay?
A copayment—or copay—is generally a:
fixed dollar amount
you pay for a covered service.
HealthCare.gov gives an example of a plan with a:
$20 doctor’s-office copay.
If the plan’s allowed amount for the visit is $100 and the applicable deductible has already been satisfied, the member pays:
$20
while the insurance company pays the remaining applicable covered amount.
Your plan might instead have:
$25 primary-care copay
$50 specialist copay
$75 urgent-care copay
or:
different copays for prescription-drug tiers.
These numbers are illustrations only.
Copays Can Differ Within the Same Health Plan
Don’t assume:
“My copay is $30.”
You may actually have:
several different copays.
For example:
| Service | Illustrative Copay |
|---|---|
| Primary-care visit | $30 |
| Specialist | $60 |
| Urgent care | $75 |
| Generic prescription | $15 |
| Preferred brand prescription | $45 |
HealthCare.gov specifically notes that copay amounts can vary for different services, including drugs, laboratory tests and specialist visits.
Check your:
Summary of Benefits and Coverage (SBC)
for the actual amounts.
What Is Coinsurance?
Coinsurance works differently.
Instead of paying a fixed amount, you pay:
a percentage of the allowed cost.
Suppose your plan has:
20% coinsurance
and the insurer’s allowed amount for a covered service is:
$1,000.
After satisfying any applicable deductible:
You pay: $200
Insurance pays: $800
HealthCare.gov uses the same basic concept: if an office visit has a $100 allowed amount and your coinsurance is 20%, you pay $20 after meeting the deductible.
Why Coinsurance Can Be Harder to Predict
With a copay, you might know before your appointment:
“I’ll owe $40.”
Coinsurance can be less predictable because:
20% isn’t a dollar amount.
It depends on the underlying allowed cost.
Consider 20% coinsurance:
| Allowed Cost | Your 20% Coinsurance |
|---|---|
| $100 | $20 |
| $500 | $100 |
| $1,000 | $200 |
| $5,000 | $1,000 |
| $20,000 | $4,000 |
The percentage stays:
exactly the same.
But your dollar responsibility changes dramatically.
What Is the “Allowed Amount”?
This is critical for understanding coinsurance.
The allowed amount is generally the maximum amount the health plan recognizes for a covered service under its payment arrangement.
HealthCare.gov also refers to this concept as an:
eligible expense
payment allowance
or:
negotiated rate.
Suppose a hospital’s nominal charge is:
$10,000.
But your insurer’s in-network allowed amount is:
$6,000.
If your applicable coinsurance is 20%, the simplified calculation would ordinarily be based on:
$6,000,
not necessarily the hospital’s original $10,000 charge.
Your portion would be:
$1,200,
assuming the deductible has already been met and no other policy rules alter the calculation.
Copay Example: Primary-Care Visit
Suppose:
Doctor’s allowed amount: $150
Your copay: $30
Applicable deductible: Already satisfied
You pay:
$30.
The amount is relatively predictable.
That’s one reason consumers often find:
copays easier to understand.
Coinsurance Example: MRI
Suppose:
MRI allowed amount: $1,500
Coinsurance: 20%
Deductible: Already satisfied
Calculation:
$1,500 × 20%
=
$300.
You pay:
$300.
The plan pays the applicable remainder:
$1,200.
Again, this is a simplified hypothetical example.
Coinsurance Example: Surgery
Now suppose you need a covered procedure with an allowed amount of:
$20,000.
Your coinsurance is:
20%.
If you’ve already met the deductible, the simple calculation would be:
$20,000 × 20%
=
$4,000.
That illustrates why coinsurance can create substantially higher bills than:
a routine office copay.
However, the plan’s:
out-of-pocket maximum
may limit how much qualifying in-network cost sharing you ultimately pay during the year.
The Deductible Changes Everything
You can’t properly understand copays or coinsurance without understanding:
the deductible.
HealthCare.gov defines a deductible as the amount you pay for certain covered health services before your insurance plan begins paying its share.
Suppose your plan has a:
$2,000 deductible.
For services subject to that deductible, you may initially pay the:
full allowed amount
until you’ve spent $2,000 toward the deductible.
Afterward, you might pay:
copays or coinsurance
according to the plan.
Does a Copay Apply Before the Deductible?
Sometimes.
This is where generic health-insurance explanations can become misleading.
Some plans cover certain services using a copay:
before you’ve met the deductible.
Other services may require you to:
satisfy the deductible first.
HealthCare.gov notes that many plans cover certain services before the deductible is met, while Marketplace plans also cover specified preventive benefits without requiring the deductible first.
Therefore, don’t assume:
“I always have to meet my deductible before I can use a copay.”
Check your plan.
Does Coinsurance Usually Apply After the Deductible?
Often, yes.
HealthCare.gov defines coinsurance as the percentage of costs you pay for a covered health service:
after paying the deductible.
Consider:
Deductible: $2,000
Coinsurance: 20%
Allowed medical expenses: $7,000
In a simplified scenario, you could pay:
First $2,000
toward the deductible.
Remaining amount:
$5,000.
Then 20% coinsurance:
$1,000.
Total:
$3,000.
The insurer would pay the applicable remaining $4,000.
A Full Example: Deductible + Coinsurance
HealthCare.gov provides a useful example involving:
$3,000 deductible
20% coinsurance
$12,000 of allowed medical costs.
The patient pays:
$3,000 deductible.
That leaves:
$9,000.
20% of $9,000:
$1,800.
Total patient spending:
$4,800.
The example demonstrates how deductible and coinsurance work sequentially.
Where Does Your Premium Fit?
Your premium is different from:
Deductible
Copay
and:
Coinsurance.
Your premium is the amount you pay to maintain:
insurance coverage.
You may pay premiums every month even if you:
don’t receive medical care.
Cost sharing generally refers to deductibles, copays and coinsurance rather than the premium itself.
Premium vs. Deductible vs. Copay vs. Coinsurance
| Cost | Meaning | Example |
|---|---|---|
| Premium | Amount paid to maintain coverage | $450/month |
| Deductible | Amount paid before plan begins sharing certain covered costs | $2,000/year |
| Copay | Fixed charge for a covered service | $30 |
| Coinsurance | Percentage of allowed cost | 20% |
| Out-of-pocket maximum | Annual ceiling on qualifying cost sharing | Depends on plan |
Examples are hypothetical.
These five numbers together tell you much more about a health plan than:
the premium alone.
What Is the Out-of-Pocket Maximum?
The out-of-pocket maximum is one of the most important consumer protections in a health plan.
HealthCare.gov defines it as the most you have to pay during a plan year for covered services subject to the limit. After reaching it, the health plan pays 100% of covered benefits for the remainder of the plan year.
Amounts generally contributing toward the limit include qualifying:
Deductibles
Copays
and:
Coinsurance.
But the limit doesn’t generally include:
Monthly premiums
Non-covered services
Out-of-network care
or:
Amounts above the plan’s allowed amount that a provider may charge, where applicable.
2026 ACA Marketplace Out-of-Pocket Maximum
For the 2026 plan year, the maximum annual cost-sharing limit for Marketplace plans is:
$10,600 for an individual
and:
$21,200 for a family.
These are:
federal maximum limits,
not amounts every Marketplace plan must use.
A particular plan can have:
a lower out-of-pocket maximum.
That distinction is important.
Example: When Coinsurance Reaches the Out-of-Pocket Maximum
Suppose your plan has:
$2,000 deductible
20% coinsurance
$7,000 out-of-pocket maximum
and you experience a serious medical year.
After your qualifying:
deductibles
copays
and:
coinsurance
reach:
$7,000,
the plan would generally pay 100% of additional covered in-network benefits subject to the out-of-pocket limit for the rest of that plan year.
You would still normally continue paying:
your insurance premiums.
Which Is Better: Copay or Coinsurance?
There’s no universal answer.
From a budgeting perspective:
a copay can be easier to predict.
If you know:
Specialist visit = $60
you know roughly what you’ll owe for that particular service.
With:
20% coinsurance,
you may not know the exact dollar amount until you know:
the plan’s allowed cost.
But that doesn’t mean a plan using copays is automatically:
better or cheaper overall.
Why a Copay Plan Can Still Cost More
Imagine:
Plan A
Premium: $600/month
Specialist copay: $40
Plan B
Premium: $450/month
Specialist coinsurance: 20%
Plan A looks attractive when you:
visit specialists.
But you’re paying:
$150 more every month.
That’s:
$1,800 more per year
in premiums.
Whether Plan A is actually cheaper depends on:
How much care you use
Deductibles
Allowed costs
Prescription expenses
Out-of-pocket maximums
and:
other plan provisions.
Don’t Choose Health Insurance Based on Copays Alone
A plan advertising:
“$20 doctor visits”
can sound excellent.
But imagine it also has:
High monthly premium
Large hospital coinsurance
High prescription costs
and:
A narrow provider network.
The $20 copay tells you:
almost nothing about total annual cost.
HealthCare.gov advises consumers to consider total costs, which can include premiums, deductibles and other out-of-pocket spending.
Where Are Copays Commonly Used?
Depending on the plan, copays may commonly apply to:
Primary-care visits
Specialist visits
Urgent care
Mental-health visits
Physical therapy
Prescription drugs
and sometimes:
Emergency-room services.
But plan designs vary substantially.
Never assume that because your previous policy charged:
a $50 specialist copay,
your new policy will work the same way.
Where Is Coinsurance Commonly Used?
Coinsurance is often seen for more expensive services such as:
Hospital care
Outpatient surgery
Advanced imaging
Specialty medications
Durable medical equipment
Diagnostic testing
and other services.
Again:
the actual policy controls.
Prescription Drugs Can Use Both
Prescription benefits frequently use:
tiers.
For example:
| Drug Tier | Illustrative Cost Sharing |
|---|---|
| Tier 1 Generic | $15 copay |
| Tier 2 Preferred Brand | $45 copay |
| Tier 3 Non-Preferred | $80 copay |
| Specialty Drug | 25% coinsurance |
This is only an example.
The important lesson is:
One insurance plan can use both copays and coinsurance.
Why Specialty Drugs Deserve Special Attention
Suppose a specialty medication has an allowed monthly cost of:
$6,000.
At:
25% coinsurance,
the simple calculation is:
$1,500.
That’s very different from:
a $50 prescription copay.
If you regularly take expensive medication, check:
Formulary
Drug tier
Deductible
Copay
Coinsurance
Prior authorization
and:
Out-of-pocket maximum.
Don’t choose a health plan based only on:
doctor-visit costs.
Emergency Room: Copay or Coinsurance?
It could be:
either.
A plan might charge:
$300 ER copay
or:
20% coinsurance
or potentially:
deductible plus coinsurance,
depending on plan design.
Some plans may waive an ER copay if you’re:
admitted to the hospital.
Always check the SBC.
Hospitalization Can Reveal the Biggest Difference
Suppose two plans cover a hospitalization.
Plan A
Hospital copay:
$1,000
Plan B
Hospital coinsurance:
20%.
If the applicable allowed amount under Plan B is:
$20,000,
20% equals:
$4,000.
At first glance:
Plan A looks much better.
But you still need to compare:
Deductible
Premium
Out-of-pocket maximum
and:
Other cost sharing.
One line item doesn’t determine:
the best plan.
Preventive Care Is Different
Marketplace plans generally cover specified preventive services without requiring you to first satisfy the deductible.
That can include qualifying preventive services when:
plan requirements are met.
Don’t assume, however, that every service performed during a preventive visit is:
automatically free.
If additional diagnostic or non-preventive services are performed, cost sharing may apply.
In-Network vs. Out-of-Network Changes the Calculation
A low coinsurance percentage doesn’t necessarily mean:
low cost
if you use an out-of-network provider.
Plans may have:
Different out-of-network coinsurance
Different deductibles
Different allowed amounts
or:
No out-of-network coverage except in specific circumstances.
Out-of-network spending also doesn’t necessarily count toward the Marketplace plan’s standard in-network out-of-pocket maximum. HealthCare.gov explicitly excludes out-of-network care from the expenses that must count toward that maximum.
Network status matters.
Example: 20% Doesn’t Always Mean 20% of the Provider’s Bill
Suppose:
Provider charge: $2,000
In-network allowed amount: $1,200
Coinsurance: 20%
After the deductible:
20% of $1,200 = $240.
You shouldn’t automatically calculate:
20% of $2,000.
The plan’s:
allowed amount
is critical.
Copay vs. Coinsurance for Frequent Doctor Visits
Suppose you expect:
12 specialist visits
during the year.
Plan A charges:
$50 copay.
Annual specialist cost:
12 × $50
=
$600.
Plan B charges:
20% coinsurance.
If each visit has a $250 allowed amount:
$250 × 20%
=
$50 per visit.
Again:
$600 annually.
In this simplified example:
they’re equal.
But if the allowed amount is $400:
20% = $80
12 × $80
=
$960.
That’s why your expected:
health-care usage
matters.
Copay vs. Coinsurance for Low Medical Use
Now consider a healthy person who:
Rarely sees a doctor
Takes no regular prescriptions
and:
Doesn’t expect major treatment.
A plan with:
higher cost sharing but lower premiums
could potentially produce lower annual spending.
But unexpected:
Accidents
Illness
or:
Hospitalization
can change that calculation quickly.
Health insurance isn’t only about:
expected expenses.
It’s also about:
financial protection from unexpected expenses.
Copay vs. Coinsurance for Chronic Conditions
Someone managing:
Diabetes
Asthma
Arthritis
Heart disease
or another chronic condition may regularly need:
Specialists
Lab work
Imaging
Medication
and:
Medical equipment.
For that person, small differences in:
copays and coinsurance
can accumulate across the year.
A higher-premium plan with lower cost sharing could potentially produce:
lower total annual costs.
The only way to know is to compare:
the entire plan.
What About High-Deductible Health Plans?
High-deductible health plans can operate differently from plans that provide many services through copays before the deductible.
Depending on the plan, you may pay the:
negotiated allowed cost
for many non-preventive services until satisfying the deductible.
Afterward:
coinsurance or other cost sharing
may apply.
This makes it especially important to distinguish:
“I have a $30 copay listed”
from:
“I can always receive this service for $30 from day one.”
Read how the deductible applies.
Cost-Sharing Reductions Can Change the Picture
Some eligible Marketplace consumers can receive:
cost-sharing reductions (CSRs).
HealthCare.gov explains that CSRs can lower:
Deductibles
Copayments
Coinsurance
and:
Out-of-pocket maximums.
But there’s an important condition:
You generally must enroll in a Silver Marketplace plan to receive these extra savings.
If you qualify, comparing a subsidized Silver plan only by premium against another metal level can therefore be misleading.
Bronze, Silver, Gold and Platinum Don’t Mean Quality
Marketplace metal categories describe:
how costs are shared,
not:
the quality of medical care.
HealthCare.gov says Bronze, Silver, Gold and Platinum categories are based on how the consumer and plan split total costs.
A Gold plan isn’t necessarily:
“better doctors.”
It generally represents a different:
cost-sharing structure.
Medicare Also Uses Coinsurance
Coinsurance isn’t limited to private health insurance.
Under Original Medicare Part B, beneficiaries generally pay:
20% of the Medicare-approved amount
for many covered services after satisfying the annual Part B deductible.
For 2026, Medicare lists the Part B deductible as:
$283.
After that deductible, 20% coinsurance commonly applies to many Part B-covered services.
Medicare Can Use Copays Too
Medicare cost sharing isn’t universally:
20% coinsurance.
For example, Medicare explains that a Part B diagnostic test performed in a hospital outpatient setting may involve:
an additional hospital copayment
on top of other applicable cost sharing.
Medicare Advantage plans can also have their own:
copays
coinsurance
networks
and:
out-of-pocket limits.
So Medicare beneficiaries also need to read:
plan-specific cost-sharing details.
Copay vs. Coinsurance: Which Is More Predictable?
Usually:
Copay.
A fixed:
$40
is easier to budget than:
20% of an unknown amount.
This can be particularly valuable for people who regularly use:
Specialists
Therapy
Urgent care
or:
Prescription medications.
But predictability and affordability aren’t:
the same thing.
A predictable $100 copay can still be expensive.
Which Can Become More Expensive?
Potentially:
coinsurance,
especially for high-cost medical services.
20% of:
$100
is only:
$20.
But 20% of:
$25,000
is:
$5,000.
The out-of-pocket maximum can provide an important ceiling for qualifying covered in-network care, but coinsurance can still cause substantial bills before you reach it.
Is 10% Coinsurance Always Better Than a $50 Copay?
No.
Suppose the allowed amount is:
$300.
10% coinsurance:
$30.
That’s cheaper than:
a $50 copay.
But suppose the allowed amount is:
$2,000.
10%:
$200.
Now the $50 copay would have been cheaper.
You need to know:
what service you’re comparing.
How to Compare Two Health Plans Properly
Don’t ask only:
“What’s the copay?”
Instead compare:
1. Monthly Premium
What will you pay whether or not you use care?
2. Deductible
How much could you pay before major cost sharing begins?
3. Primary-Care Copay
Especially important for frequent routine visits.
4. Specialist Cost
Copay or coinsurance?
5. Hospital Cost
This can create major expenses.
6. Imaging
Check MRI, CT and diagnostic services.
7. Prescription Drugs
Review your actual medications.
8. Out-of-Pocket Maximum
This can matter enormously during a serious medical year.
9. Provider Network
Are your doctors and hospitals in network?
10. Drug Formulary
Are your medications covered?
Three Health-Care Scenarios
Scenario 1: Low Use
You have:
One annual checkup
One sick visit
No regular medication.
Premium may have a large influence on:
total annual cost.
Scenario 2: Moderate Use
You have:
Several doctor visits
Two specialist appointments
Regular prescriptions
and:
One diagnostic test.
Now:
copays and coinsurance
become more important.
Scenario 3: High Use
You experience:
Hospitalization
Surgery
Imaging
Specialist treatment
and:
Expensive medication.
Now the:
deductible + coinsurance + out-of-pocket maximum
may be far more important than a:
$20 difference in office copays.
A Simple Annual-Cost Comparison
Consider two hypothetical plans.
| Feature | Plan A | Plan B |
|---|---|---|
| Monthly Premium | $450 | $600 |
| Annual Premium | $5,400 | $7,200 |
| Deductible | $3,500 | $1,500 |
| Primary Care | $40 copay | $25 copay |
| Specialist | $75 copay | $45 copay |
| Hospital | 30% coinsurance | 15% coinsurance |
| OOP Maximum | $9,000 | $6,000 |
If you barely use health care:
Plan A may potentially cost less.
If you have a year involving surgery and hospitalization:
Plan B’s lower deductible, coinsurance and out-of-pocket maximum could become valuable.
Neither is universally:
“better.”
Questions to Ask Before Choosing a Plan
Ask:
- Does this copay apply before or after my deductible?
- Which services use coinsurance?
- What is the allowed amount?
- Do prescriptions have a separate deductible?
- What’s my in-network deductible?
- What’s my out-of-pocket maximum?
- What doesn’t count toward that maximum?
- Are my doctors in network?
- Is my preferred hospital in network?
- How are specialist visits covered?
- How is outpatient surgery covered?
- What do I pay for an MRI?
- What do I pay for an ER visit?
- How are specialty drugs covered?
- Does the plan have separate individual and family deductibles?
These questions provide a much better picture than:
“Does this plan have copays?”
Common Copay and Coinsurance Mistakes
Mistake 1: Thinking They’re the Same
They’re not.
Copay = fixed amount.
Coinsurance = percentage.
Mistake 2: Ignoring the Deductible
Your deductible can determine:
when
copay or coinsurance provisions begin applying.
Mistake 3: Calculating Coinsurance From the Sticker Price
Coinsurance is generally tied to the plan’s:
allowed amount,
not simply whatever number appears on an initial provider bill.
Mistake 4: Assuming Every Copay Applies Before the Deductible
Plan rules vary.
Mistake 5: Choosing a Plan Based on Doctor Copay Alone
Hospital, prescription and specialist expenses can matter much more.
Mistake 6: Ignoring the Out-of-Pocket Maximum
For someone expecting high medical expenses, this may be one of the most important numbers in the plan.
Mistake 7: Forgetting Premiums
A low-copay plan can have:
significantly higher premiums.
Mistake 8: Assuming Out-of-Network Costs Work the Same Way
They may not.
Copay vs. Coinsurance Checklist
| Question | Check |
|---|---|
| What is my monthly premium? | ☐ |
| What is my deductible? | ☐ |
| Do office copays apply before deductible? | ☐ |
| What is my primary-care copay? | ☐ |
| What is my specialist copay? | ☐ |
| Which services use coinsurance? | ☐ |
| What is my hospital coinsurance? | ☐ |
| How is imaging covered? | ☐ |
| How are prescriptions covered? | ☐ |
| Is there a separate drug deductible? | ☐ |
| What is my out-of-pocket maximum? | ☐ |
| Are my doctors in network? | ☐ |
| Are my medications on the formulary? | ☐ |
| Do I qualify for Marketplace cost-sharing reductions? | ☐ |
| What would my total annual cost look like in a high-use year? | ☐ |
Frequently Asked Questions
What is the main difference between a copay and coinsurance?
A copay is generally a fixed dollar amount for a covered service. Coinsurance is a percentage of the allowed cost of a covered service.
Is a $30 copay better than 20% coinsurance?
Not necessarily. It depends on the service’s allowed amount, deductible, premium and other plan provisions. If the allowed amount is $100, 20% equals $20. If it’s $1,000, 20% equals $200.
Do I pay coinsurance before meeting my deductible?
Typically, coinsurance applies after you’ve met the applicable deductible, although plan structures vary.
Can I have copays before meeting my deductible?
Yes. Some plans cover certain services before the deductible is satisfied. Always check your specific benefits.
Do copays count toward my out-of-pocket maximum?
Qualifying copayments for covered in-network services generally count toward the applicable out-of-pocket maximum.
Does coinsurance count toward the out-of-pocket maximum?
Qualifying coinsurance for covered in-network services generally counts toward it as well.
Do monthly premiums count toward my out-of-pocket maximum?
No. HealthCare.gov specifically excludes monthly premiums from the Marketplace out-of-pocket limit.
What is the maximum out-of-pocket limit for a 2026 Marketplace plan?
For 2026, the federal maximum is $10,600 for individual coverage and $21,200 for family coverage. Individual plans may have lower limits.
Does Medicare use coinsurance?
Yes. Under Original Medicare Part B, beneficiaries generally pay 20% of the Medicare-approved amount for many covered services after satisfying the deductible.
Which should I look at when choosing health insurance?
Look at all of them: premium, deductible, copays, coinsurance and out-of-pocket maximum. Also review the provider network, prescription formulary and your expected medical needs.
Key Takeaways
The difference between copays and coinsurance is simple:
Copay = fixed dollar amount
Coinsurance = percentage of the allowed cost.
But determining which costs less isn’t nearly as simple.
A:
$40 copay
may be cheaper than:
20% coinsurance
for an expensive service.
But 20% coinsurance could be cheaper when:
the allowed cost is low.
Your deductible also matters because many services don’t shift to copays or coinsurance until the applicable deductible has been satisfied. Some services, however, can be covered before the deductible.
And your out-of-pocket maximum provides another important piece of the equation. For 2026 Marketplace coverage, the federal maximum is $10,600 for an individual and $21,200 for a family, although plans can use lower limits.
So when comparing health plans, don’t ask:
“Which one has the lowest copay?”
Ask:
What could this plan realistically cost me over the entire year?
Compare:
Premium
Deductible
Copays
Coinsurance
Out-of-pocket maximum
Provider network
and:
Prescription coverage.
That’s the comparison that reveals the true financial difference between health plans.
Disclaimer
This article is for general educational and informational purposes only and isn’t personalized health, insurance, financial, tax or legal advice. Health-plan benefits, deductibles, copays, coinsurance, networks and out-of-pocket limits vary by policy. Always review the applicable Summary of Benefits and Coverage and insurance contract before choosing or using coverage.