See health rates

Health Insurance Guide

Updated: May 1, 2026Written byRai AntonioReviewed byDavid Krug
Compare rates in your area

● Health Insurance

Live health rates from the carriers we've reviewed. Carriers pay us only when you switch.

Why trust QuoteYeti

QuoteYeti's editorial team has spent 30+ combined years researching insurance markets. Every piece is written by named writers, reviewed by our editor-in-chief against the QuoteYeti methodology, and rate-heavy content is verified by our data team. No paid placements. Read our editorial standards →

Understanding deductibles, copays, and coinsurance

How the three cost-sharing mechanisms work and how they affect what you pay.

Health insurance cost-sharing terminology is genuinely confusing. Here’s what each piece means in plain English.

Deductible

The amount you pay before insurance starts covering costs. If your deductible is $3,000, you pay the first $3,000 of covered medical expenses yourself. After that, insurance kicks in.

Important nuances:

  • Some services (preventive care, sometimes certain visits) may be covered before you hit the deductible
  • Deductibles reset each year
  • Family vs. individual deductibles work differently — read your plan
  • HSA-eligible “high deductible” plans have higher deductibles in exchange for HSA tax benefits

Copay

A fixed dollar amount you pay for a specific service. $30 for a primary care visit, $50 for a specialist, $10 for a generic prescription.

Copays are typically charged at the time of service. They may or may not count toward your deductible depending on the plan.

Coinsurance

The percentage of cost you pay after you’ve met your deductible. If your coinsurance is 20%, after meeting your deductible, you pay 20% of all covered services until you hit your max out-of-pocket.

Example: You’ve met your $3,000 deductible. You have a $2,000 procedure. With 20% coinsurance, you pay $400 (20%) and insurance pays $1,600.

Maximum out-of-pocket (MOOP)

The annual ceiling on what you’ll pay. Once you’ve hit the MOOP, insurance covers 100% of in-network covered services for the rest of the year. Premiums don’t count toward MOOP.

For 2024, ACA marketplace plans have MOOP capped at $9,450 individual / $18,900 family.

Putting it together — a worked example

Plan structure:

  • Deductible: $3,000
  • Coinsurance: 20%
  • Max out-of-pocket: $8,000
  • PCP copay: $30

Scenario 1: Healthy year.

  • 2 PCP visits = $60 in copays
  • Annual cost: $60

Scenario 2: Moderate year.

  • 4 PCP visits = $120
  • 1 specialist visit = $50 copay
  • 1 lab procedure = $800 (counts toward deductible)
  • Annual cost: $970 (you haven’t hit the deductible)

Scenario 3: Heavy year.

  • All the above ($970)
  • 1 major surgery = $25,000
  • You pay: remaining deductible ($2,030) + 20% coinsurance on amount above deductible until you hit MOOP
  • 20% of ($25,000 - $2,030) = $4,594, but capped at the difference between $2,970 already paid and $8,000 MOOP
  • Your total: $8,000 (you hit MOOP)
  • Insurance covers everything else for the year

How to use this when choosing plans

Bronze/Silver/Gold/Platinum tiers trade off premium vs. cost-share:

  • Bronze: low premium, high deductible/coinsurance — good for healthy people who won’t use much care
  • Silver: middle ground; cost-sharing reductions available for lower incomes
  • Gold/Platinum: higher premium, lower cost-share — good for people who expect significant medical use

The right plan for you depends on expected total annual cost (premium + expected out-of-pocket). For most people:

  • Heavy users: Gold or Platinum
  • Light users: Bronze or Silver (with potential cost-share reductions)
  • Moderate users with HSA goals: HSA-eligible HDHP (often a Bronze or Silver)