How deductibles, copays and coinsurance interact

These three numbers on a health plan summary only make sense as a sequence — each one applies at a different stage of paying for care.

The deductible comes first

Until you've spent this amount out of pocket in the plan year, you generally pay the full negotiated cost of care yourself (with common exceptions like preventive visits, which are often covered before the deductible is met).

Copays are flat fees for specific visits

A copay — say, $30 for a primary care visit — is often separate from the deductible logic; some plans apply copays before the deductible is met, others don't. Check your plan's summary of benefits for which applies.

Coinsurance kicks in after the deductible

Once you've met your deductible, coinsurance is your percentage share of costs — commonly 20%, with the insurer covering the rest — until you hit your out-of-pocket maximum.

A worked example

Say your plan has a $2,000 deductible, 20% coinsurance, and a $6,000 out-of-pocket max. A $10,000 hospital stay: you pay the first $2,000 (deductible), then 20% of the remaining $8,000 ($1,600) in coinsurance — a total of $3,600, below your out-of-pocket max, so you'd pay that full $3,600 yourself.

The out-of-pocket maximum is your safety net

Once total out-of-pocket spending (deductible + coinsurance + copays, depending on plan rules) reaches this cap, the insurer pays 100% of covered costs for the rest of the plan year.