4 / 10
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 4 · A fresh plan year
Start again from zero. It is January, you have spent nothing, and you need a surgery with an allowed price of $5,000.
What do you pay?
Correct!
Not quite.
Two numbers apply, one after the other. First the deductible: you pay the first $2,000. That leaves $3,000 of the bill, and coinsurance applies to it: 20 percent of $3,000 is $600. Total: $2,600. People often expect either “20 percent of $5,000,” which is $1,000, or “just the deductible.” The real answer is the two added together.