How does insurance work? What is a deductible? What is a copay? What is coinsurance?

Your health insurance is like a personalized roadmap, ensuring you have the support you need for your healthcare journey. It’s a plan (also often called “a policy”) for which you or your employer pays a monthly premium to help cover some of the costs associated with healthcare (e.g., appointments, hospital visits, etc.). Each service will have a cost-share (e.g., copay, coinsurance) outlining how much you would pay for the service, and whether your deductible applies.

A deductible is a fixed amount you must pay each year before your insurance plan begins to share in the costs for all services. Some services may have a cost-share in which the deductible does not apply while other services may require that the deductible is met before the cost-share applies.

A copay is a fixed amount you pay for medical services with the remaining balance covered by your insurance provider. Copays will usually vary, depending on the service provided and in many cases, the deductible does not apply when there is a copay. However, please refer to your insurance plan’s Summary of Benefits and Coverage (SBC) to confirm.

Coinsurance is the percentage of costs of a healthcare service that you pay (e.g., 20% coinsurance indicates that you are responsible for 20% of the cost of the service), with the remaining balance covered by your insurance provider. Coinsurance usually applies after you’ve met your deductible, meaning you’ll be responsible for paying the full service cost until you reach your deductible.

If you have any questions around how your insurance plan works, please directly reach out to your insurance provider.