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Health Insurance Costs Explained

Learn the difference between premiums, deductibles, copays, coinsurance, and out-of-pocket maximums.

Health insurance costs include more than the monthly premium. A plan may have a lower premium but higher cost-sharing when you use care, or a higher premium with different deductibles and network rules. The right comparison depends on your expected care needs and the plan details that matter to you.

Monthly premium

The premium is the amount charged to keep the plan active. It is separate from deductibles and copayments. If you qualify for a premium tax credit, the amount you pay may differ from the plan's full premium.

Deductible

The deductible is the amount you pay for covered services subject to the deductible before the plan begins paying its share for those services. Some services may be covered before the deductible, depending on the plan.

Copay and coinsurance

A copayment is a fixed dollar amount for a service. Coinsurance is generally a percentage of the allowed cost for a covered service. Check how each applies to office visits, prescriptions, tests, and hospital services.

Out-of-pocket maximum

The out-of-pocket maximum limits what you pay for covered in-network essential health benefits during the plan year under the plan's rules. Premiums, non-covered services, and some out-of-network costs generally do not count toward this limit. Read the plan document for details.

Official resource: HealthCare.gov: total costs.

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