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When you budget for your health care, it's important to consider the expenses. You have a monthly premium and other out-of-pocket costs. Depending on your plan, costs could include copays, coinsurance and deductibles for medical services and prescriptions. Thanks to out-of-pocket maximums, there is a limit on what you'll spend in a year. 

You may not reach that yearly limit, so how can you gauge your out-of-pocket costs? Take a look at your recent health history. By using last year's expense as a guide, you can get a general idea of how much to budget for some of your reoccurring out-of-pocket costs.

Of course, the unexpected can happen. You get sick. You break a bone. You need surgery. While you can't predict these events, it's important to understand that they can increase your out-of-pocket costs — and you might plan for them just in case.


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Out of Pocket Costs*

Copay plus Coinsurance plus Deductible

*Out-of-pocket costs vary by plan

About Your Deductible 

A deductible is another portion of your out-of-pocket costs. It's often the amount you pay for your health costs before your plan benefits start to pay. Because you pay some of your deductible with each visit or service, it helps to hold down the cost of your premiums. By thinking about your needs and the deductible included in each plan, you can find the right deductible for your budget. For example, if you don’t see doctors that often, a lower-premium, higher-deductible plan could be right for you. In fact, the money you save with lower premiums can pay for your deductibles. 

What's Coinsurance? 

This is a percentage of your medical bill you share with your insurance company on certain services. For example, if you have a $2,000 hospital bill and your coinsurance is 25 percent, you pay $500. Your plan pays the other $1,500.

You pay coinsurance until you reach your out-of-pocket maximum. Every plan is different.

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Coinsurance Example for $2,000 Hospital Bill*

You pay 25% coinsurance, plan pays 75% until out-of-pocket maximum met

Then plan pays 100%


*Out-of-pocket costs vary by plan.

How a Copay Works 

A copay is the fixed amount you pay for covered health care services, like doctor visits and prescriptions. In most plans, you’ll pay different copays for different services until you reach your out-of-pocket maximum. These copays amount to a portion of the overall cost of having health insurance. 

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Copay Example for $200 In-Network Doctor Visits*

You pay $25 for copay

Plan pays $175

*Out-of-pocket costs vary by plan and type of service.

Know Your Out-of-Pocket Maximum

All plans have them. The out-of-pocket maximum is what you pay during a policy period before your health insurance plan begins paying 100 percent of your covered medical expenses.