Many people are confused about the differences between an insurance deductible, co-pay, and coinsurance. What are they and how do they differ from each other?
In short, all three represent the portion of the medical bill that you are responsible for in case you get sick or injured – otherwise known as out-of-pocket expenses. However, there are some very unique differences between each one, and we are here to help guide you and understand what each word means in detail.
Deductible
A deductible is usually a fix dollar amount that you have to pay out of your own pocket before the insurance will cover the remaining eligible expenses. Depending on the insurance plan, the deductible can range from $0 all the way up to thousands of dollars. It can also be paid per sickness/injury (per condition) or per certificate period.
As a rule of thumb, the higher the deductible the lower the premium (price to buy the plan), and vice versa – but always be sure to choose the deductible that is appropriate for your circumstances when purchasing an insurance policy.
Coinsurance
Coinsurance is usually a percentage, and represents the percentage cost that you will need to pay and the insurance plan will pay towards your eligible medical expenses. Some common coinsurance examples include: 100%, 80/20, 90/10 and 50/50 – so if you have 80/20 coinsurance on your insurance plan, it means that the insurance company will cover 80% of your medical cost and you are responsible for paying the other 20% yourself. A deductible is commonly used together with coinsurance. In this case you would pay the deductible amount first and after you would have the left over coinsurance amount.
Copay (copayment)
Copays are similar to deductibles, and that it is usually a fixed amount of money you have to pay each time you need to use your insurance plan. Unlike deductibles, copays tend to be smaller dollar amounts and are applied on a per visit basis so that you would have to pay it each visit.
Learn more about our Student Health Advantage with small co-paysWith most insurance plans, you will typically see some combination of deductible, coinsurance and copayments – or in some cases your plan may not have any of them. It will very much depend on your specific insurance plan so be sure to check the policy details so you know what your out-of-pocket payments will be. For more information about insurance terms, and to help guide you further please visit our insurance explained section where we delve into all areas of insurance to help you understand insurance plans more!
Some plans that could be a good fit for your needs if you are a student:
Student Secure Student Health Learn more Learn more Some plans that could be a good fit for your needs if you are a traveler:
Atlas Travel Patriot Travel Learn more Learn more You can also contact us to suggest a plan for you based on your needs.
Category: Insurance Explained, Product Information
Tags: coinsurance, copay vs coinsurance, deductible vs coinsurance, deductible vs copay, health insurance explain, insurance copay, insurance deductible, insurance out of pocket expense, International Student Travel Insurance, study abroad insurance
21 thoughts on “What’s the difference between insurance deductible, coinsurance, and copay?”
Nice explanation. It made lot clear to me now. Thanks !
Hello,
Can you help clear this out?
| In-network | Out of network
Chiropractic care | Deductible then $25 copay / 100% | 60% after deductibleIt means that I must pay towards my deductible (it’s 1500$) then I will start paying 25$ copay?
Or I just pay 25$ every visit?Thank you
Hello Peter,
Thanks for your blog comment. Unfortunately, we cannot advise you on other company’s insurance plans. I would recommend contacting your insurance company and inquiring with them what exactly they mean by a copay $25 / 100%, 60% after deductible.
Generally, the copay is in fact paid per visit. You would either be charged a deductible or a copay but not both generally. However, we cannot confirm this information for a plan that we do not sell.
Please let us know if you have any other questions or if you need a recommendation.
please tell me what is OUT OF POCKET?
Hello Khagendra,
Thanks for your blog comment. “Out of pocket” means any amount of money that you will have to pay for your medical expenses. Out of pocket charges can be your deductible, your copay, and part of your coinsurance. Some plans have coinsurance 80/20 which means that the plan pays 80% of your eligible expenses and you are responsible for 20%. Sometimes, out-of-pocket expenses may include the amount of money that you will be responsible for after you max out your plan’s benefits.
Please let us know if you have any more questions!
Hi Bryanna
can you please assist me what is co-insurance. i have so many doughts. can you please verify this in normal terms.
Hi Saransh,
Thank you for visiting our blog!
After the deductible, coinsurance applies to your benefits, and this is the cost sharing between you and the insurance plan. This is typically referred to as a percentage that the plan will pay, for example if there is 80% coverage – the insurance plan will pay 80% of your eligible medical expenses and you will need to pay the remaining 20%.
The coinsurance for your eligible medical expenses on the Student Secure plan is as follows:
Smart plan is 80% coverage
Budget plan is 80% coverage for the first $25,000 of your medical cost, then 100% after
Select plan is 80% coverage for the first $5,000 for your medical cost, then 100% after.
Elite plan is 100% coverage within the First Health NetworkTo view more information about our Student Secure plan, please visit the following link:
Please let us know if you have any further questions!
same questions as Zahraa on sept 26th.
Hi Bhadra,
Thanks for your comment. If you already have a plan please email us immediately with your ID numberand further details on the situation so we can best assist you.
same question as zahraa on sept. 26.thanks.
Hi
I have a bill for medications but the insurance not cover this bill and the bill is 2280$ and i paid the whole bill does this amount considered from the deductible
Is copay that i paid for each doctor visit considered as a detuctible
Cause i have a procedure and they said they will pay 80% after i paid the detuctible wich is 1500$ what about the bills and copay that i paid before ?
Hi Zahraa,
Thanks for your comment. If you already have a plan please email us immediately with your plan information (ID number) and further details on the situation so we can best assist you.
I am confused now….i thought co-insurance was the transfer of the primary risk by one insurer to another insurer, while the insured’s part in coinsurance is called “contribution”….pls clarify
Hi Junior,
We’re happy to help clear up any doubts you have on these terms. I’ve sent you an email to assist you further.
I’m confused between Ded, Coins and Copay. Can u give me a simle Example.
Hi Akash,
The deductible and copay will be what you must pay when you use the plan- before the insurance begins to pay. The co-insurance will be the shared cost of your remaining eligible expenses- this means you will pay a portion of your remaining bill and your insurance will pay a portion of your remaining bill.
You can call us Monday-Friday 8am-6pm EST at +1-904-758-4391 for more information on these items and to find the perfect plan for you.
With a family, how does the deductible work? I have 1,700 individual and 3,400 family. If my deductible hits 1,700 and my wife hits 1,700 does that satisfy the family deductible for any other issues that happen to not only my wife and I but our children as well?
Hi Mike – it really depends on which plan you are currently insured under, as they all handle these things differently. If you are insured under one of our plans, please email us at info@internationalstudentinsurance.com and we will answer you right away.
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Over the years, I have seen coinsurance in medical plans defined two different ways when it’s presented as a single number. Sometimes, it’s the percent I pay, sometimes it’s the percent the plan pays.
It should always be presented as two number with a clear statement of who is responsible for which number.
Hi Bob,
Thank you for your comment! Sometimes it is hard to decipher what part the plan pays vs. the patient’s responsibility when it comes to coinsurance. It is always best to view the full policy wording or master certificate, which should explain how the coinsurance is displayed. You can always call the insurance company directly and get a direct answer from them! We strive to make it clear on our plans which percentage is covered by the insurance on eligible expenses, along with the patient’s responsibility.
We hope this helps!