Learn More about Copayments, Deductibles, Coinsurance, and Out-of-Pocket Maximums

To learn more about how copayments, deductibles, coinsurance, and out-of-pocket maximums affect how much a patient is responsible for paying, see the three examples below.

Example 1

Juanita sprains her ankle and visits urgent care. She is billed for a $150 copayment and $250 for an x-ray. Her portion of coinsurance is 20%.

If Juanita has not met her deductible for the year, she will be responsible for the full amount of $400.
If Juanita has met her deductible and has not yet reached her out-of-pocket maximum for the year, she will be responsible for her copayment and coinsurance amounts. She’ll pay $150 for her copay, and $50 in coinsurance for the x-ray. Her plan will pay $200, or 80% of the bill for the x-ray.
If Juanita has reached her out-of-pocket maximum, insurance will cover the full amount of $400.

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