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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
✅
Situation 3 · Later in the year
Suppose your deductible is now fully met. You have a minor outpatient procedure with an allowed price of $1,000.
What do you pay?
Correct!
Not quite.
Coinsurance is the number that matters. Meeting the deductible does not make care free. It moves you into the next stage, where you and the plan share each bill. At 20 percent coinsurance, you pay $200 of a $1,000 procedure and the plan pays $800. This sharing continues until your total spending reaches the out-of-pocket maximum.