What does a health insurance deductible mean?

Deductible in plain English

Your deductible is the amount you pay for covered care in a plan year before your insurance starts to pay its share. If your deductible is $2,000, you pay the first $2,000 of covered care yourself (except for services the plan covers before the deductible, like some preventive care).

Copay vs coinsurance

Copay is a flat fee per visit (e.g. $30 for a primary care visit). Coinsurance is a percentage split after your deductible (e.g. 80% carrier / 20% you).

Out-of-pocket maximum

This is the ceiling. Once you've spent this much on covered in-network care in a plan year — including deductible and coinsurance — the plan pays 100% for the rest of the year. The out-of-pocket max is often more important than the deductible.

A worked example

Say your plan has a $2,000 deductible, 20% coinsurance, and a $6,000 out-of-pocket max. A $10,000 covered surgery would break down roughly like: you pay the first $2,000 (deductible), then 20% of the remaining $8,000 ($1,600) — total $3,600 out of pocket. Anything above $6,000 in a plan year is covered 100% by the plan.

Low-deductible plans often have higher monthly premiums. Whether that trade is worth it depends on how much care you expect to use. That's the honest math we run with you.