Health Insurance
Premiums, deductibles, copays, coinsurance and out-of-pocket maximums work together. Understanding the pieces helps you read a plan summary.
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Premiums
The premium is what you pay to keep the plan. Employer contributions, marketplace subsidies and Medicaid/Medicare rules can change what you personally pay. This site does not determine eligibility for public programs.
Deductibles, copays and coinsurance
You generally pay covered costs until the deductible is met, though some preventive services are covered sooner on many plans. Copays are flat fees. Coinsurance is a percentage of allowed amounts after deductible rules apply.
Out-of-pocket maximum
This cap usually limits in-network cost sharing for covered services during the plan year. Premiums typically do not count. Use current plan documents for the year’s limits.
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Frequently asked questions
Can this calculator enroll me in a plan?
No. It only illustrates how the numbers you enter can add up.