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Your plan this year
Premium$400 / month
Deductible$2,000
Primary care copay$30
Coinsurance20%
Out-of-pocket max$6,000
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Situation 2 · February
Your doctor orders an MRI. The plan’s allowed price is $1,500. Apart from that one copay, you have spent nothing toward the deductible.
What do you pay?
Correct!
Not quite.
The deductible is the number that matters. Until you have paid $2,000 in a plan year, you pay the full allowed price of most services other than those with a flat copay. The MRI costs you $1,500, and you now have $500 of deductible left. One consolation: you pay the plan’s negotiated price, which is usually far below the provider’s list price. Copays generally do not count toward the deductible.