Premiums & out-of-pocket

Learn how deductibles, copays, coinsurance, and the out-of-pocket maximum add up so you can compare plans by total cost.

Guides

Data

Common questions

Does my premium count toward my deductible or out-of-pocket maximum?

No. Premiums are what you pay to have the plan, and they do not count toward either the deductible or the out-of-pocket maximum. Only your spending on covered care counts.

What is the difference between a copay and coinsurance?

A copay is a fixed dollar amount, like $30 a visit, while coinsurance is a percentage of the cost, like 20% of the bill. Copays stay the same no matter how expensive the service is, and coinsurance grows with the price. Many plans use both, sometimes for different services.

What's the difference between a deductible and an out-of-pocket maximum?

The deductible is what you pay before the plan starts sharing costs. The out-of-pocket maximum is the most you will pay all year for covered, in-network care, after which the plan pays 100%. The deductible is the starting line; the out-of-pocket maximum is the finish line.