Understanding the three numbers that define a plan
Premium, deductible, and out-of-pocket maximum work together to show a plan's cost in the best, average, and worst-case scenarios. Understanding how these three connect is key. Other details — like copays and coinsurance — adjust the picture but rarely change the overall outcome. Most shoppers overweight the premium and underweight the deductible1.
Premium, deductible, and out-of-pocket maximum
Your premium is the fixed amount you pay every month, whether or not you use care. The deductible is what you pay yourself before the plan starts sharing costs, and the out-of-pocket maximum is the ceiling — once you hit it, the plan covers everything for the rest of the year.
How copays and coinsurance fit in
A note on provider networks
Copays are flat fees for a visit; coinsurance is a percentage you split with the plan after the deductible. Staying in network keeps both predictable — going out of network can reset everything.
- Premium — the monthly cost of simply having the plan.
