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What’s the difference between insurance deductible, coinsurance, and copay?

comparing-benefits-wordingMany people are confused about the differences between an insurance deductible, co-pay and coinsurance. What are they and how do they differ from each other?

In short, all three represent the portion of the medical bill that you are responsible for in case you get sick or injured – otherwise known as out-of-pocket expenses. However, there are some very unique differences between each one, and we are here to help guide you and understand what each word means in detail.


A deductible is usually a fix dollar amount that you have to pay out of your own pocket before the insurance will cover the remaining eligible expenses.Depending on the insurance plan, the deductible can range from $0 all the way up to thousands of dollars. It can also be paid per sickness/injury (per condition) or per certificate period. As a rule of thumb, the higher the deductible the lower the premium (price to buy the plan), and vice versa – but always be sure to choose the deductible that is appropriate for your circumstances when purchasing an insurance policy.


Coinsurance is usually a percentage, and represents the percentage cost that you will need to pay and the insurance plan will pay towards your eligible medical expenses. Some common coinsurance examples include: 100%, 80/20, 90/10 and 50/50 – so if you have 80/20 coinsurance on your insurance plan, it means that the insurance company will cover 80% of your medical cost and you are responsible for paying the other 20% yourself. A deductible is commonly use together with coinsurance. In this case you would pay the deductible amount first and after you would have the left over coinsurance amount.

Copay (copayment)

Copays are similar to deductibles, in that it is usually a fixed amount of money you have to pay each time you need to use your insurance plan. Unlike deductibles, copays tend to be smaller dollar amounts and are applied on a per visit basis so that that you would have to pay it each visit.

With most insurance plans, you will typically see some combination of deductible, coinsurance and copayments – or in some cases your plan may not have any of them. It will very much depend on your specific insurance plan so be sure to check the policy details so you know what your out-of-pocket payments will be. For more information about insurance terms, and to help guide you further please visit our insurance explained section where we delve into all areas of insurance to help you understand insurance plans more!

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Originally from Thailand, Apinant grew up in the United States and has extensive international experience traveling throughout Asia, Australia, North America and Europe. He has lived, studied and worked abroad in China, England, Taiwan and Thailand. Apinant is a graduate of the University of Florida with a Masters in International Business and a Bachelors of Science in Business Management.

16 Responses to “What’s the difference between insurance deductible, coinsurance, and copay?”

capsicum says:

I delight in, lead to I found exactly what I used to be having a look for. You have ended my four day long hunt! God Bless you man. Have a great day. Bye

Mike says:

With a family, how does the deductible work? I have 1,700 individual and 3,400 family. If my deductible hits 1,700 and my wife hits 1,700 does that satisfy the family deductible for any other issues that happen to not only my wife and I but our children as well?

Hi Mike – it really depends on which plan you are currently insured under, as they all handle these things differently. If you are insured under one of our plans, please email us at info@internationalstudentinsurance.com and we will answer you right away.

syed ali waqas says:

i like explanation you have mentioned.Thanks

akash says:

I’m confused between Ded, Coins and Copay. Can u give me a simle Example.

Bryanna Davis says:

Hi Akash,

The deductible and copay will be what you must pay when you use the plan- before the insurance begins to pay. The co-insurance will be the shared cost of your remaining eligible expenses- this means you will pay a portion of your remaining bill and your insurance will pay a portion of your remaining bill.

You can call us Monday-Friday 8am-6pm EST at +1-904-758-4391 for more information on these items and to find the perfect plan for you.

[…] Difference between insurance deductible, coinsurance, … – Learn about what the difference between insurance deductible, coinsurance, and copay are to help educate you on your insurance plan and understand it more…. […]

Anthony Neel says:

If i am not wrong Deductibles are paid annually and copays are paid per visit. Where as Coinsurance also per visit.

Bryanna Davis says:

Hi Anthony,

It will depend on the plan. While some plans have a deductible that is an annual, or per certificate period, other plans might have a per injury or illness deductible. The co-insurance will be per visit until you reach the maximum amount (if there is one) you must contribute toward the co-insurance. You will want to make sure you check out the plan documents- including the deductible and co-insurance obligations so you are prepared for whatever out of pocket expense comes your way. If you’re looking at one of our plans and would like help understanding the out of pocket expenses, please feel free to contact us.

Awasi says:

you are right saying dear.

Anthony says:

To whom a deductible has to be paid. It should be paid to insurance or provider

The deductible should always be paid to the insurance provider. If you do not pay this, it will remain as a balance with them – so make sure you always pay this to the provider

Meredith says:

I think your article has helped us decode a cryptic bit of our insurance plan but I want to make sure:
Under Emergency Care it reads, “$124 copay, 90%”. We knew, of course, that this means we have to pay $124 up front but my husband interpreted the 90% to mean that we would owe 90% of the cost of the visit in addition to the $124. So we didn’t go to the ER. I think it means we pay $124 PLUS 10% of the cost of the visit to the ER (which could still be quite high, of course, with a bag of saline costing an arm and a leg). Which of us is right?

Katy says:

I understand copay is for visit , deductibles and coins is for hospital and other services . What about if I don’t have copayment and I have deductibles and co insurance only, how much I will be paying an specialist office visit? Do I need to pay the consultation until reach my deductible ? Does deductibles and coins apply for an specialist office visit? , What about if I have only deductible ? No copay and no coins , do I pay the visit toward my deductible o I don’t have to pay? , thanks

gangatharan says:

I understand allowed amount and paid amount and difference. Then I want what about adjustment amount and difference. please explain?

Judy says:

What is the difference between a major medical/comprehensive deductible and a replacement deductible. Some plans have both.

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