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Health insurance terms can be confusing, especially when you’re trying to estimate your portion of the bill. Deductibles, copays and coinsurance all describe different ways you share costs with your insurance company. Understanding these differences can help you prepare for medical bills and compare health insurance plans with confidence.
Table of Contents
A deductible is the amount you pay out of pocket for covered health care services before your insurance begins to share costs.1 For example, if your plan has a $1,000 deductible, you'll need to pay $1,000 toward covered services before your insurer starts paying its portion.
Some plans have separate individual and family deductibles. An individual deductible applies to one person’s covered care, while a family deductible combines eligible costs for everyone covered under the same plan.
A copay, or copayment, is a fixed amount you pay for certain covered services.2 For example, you may pay a $30 copay for a general doctor’s visit or a $15 copay for a prescription.3
You typically pay copays at the time of service. You can find your copay amounts on your health insurance card or plan documents.
Coinsurance is the percentage of a covered service you pay after meeting your deductible. It typically applies to larger medical costs, such as hospital stays, surgeries or specialist care.4
If you’ve already met your deductible and need a covered procedure that costs $1,000, a 20% coinsurance means that you pay $200 and your insurance company pays $800.
Don’t wait until it’s too late. Protect yourself and your family with coverage from Aflac.
Get StartedThe main difference between a deductible and a copay is when and how you pay. A deductible is an amount you must meet before your insurance starts sharing certain costs, while a copay is a fixed fee you pay for specific services, such as a doctor’s visit.
Deductibles are usually much higher than copays. As of 2024, the average health insurance deductible in the United States was $2,085 for individual plans and $4,063 for family plans.5
Copays are usually smaller, fixed amounts, such as:6
One difference between coinsurance and a copay is the way they're calculated and expressed. As we discussed earlier, copays are specific, predetermined dollar amounts, while coinsurance is calculated as a percentage of the total cost of services.
Copay amounts depend on the type of care you receive. For example, the copay may be lower for preventative care than for an urgent care visit. They apply even if you haven't met your deductible yet.
In contrast, coinsurance typically only applies after you've met your deductible and before you've met your out-of-pocket maximum.
Your out-of-pocket maximum is the most you’ll pay for covered services during a plan year. Deductibles, copays and coinsurance usually count toward this limit, while premiums and non-covered services typically don’t.
Once you reach your out-of-pocket maximum, your insurer pays 100% of covered care for the rest of the plan year.
The main difference between deductibles and coinsurance is when each cost applies. Your deductible is the amount you pay before your insurer starts sharing the cost of many covered services. Coinsurance kicks in after you meet your deductible.
For example, if you have a $1,000 deductible and 20% coinsurance, you’ll pay the first $1,000 of eligible care costs. After that, you’ll pay 20% of covered services, while your insurer pays the remaining 80%, until you reach your out-of-pocket maximum.
Understanding deductibles, copays and coinsurance can help you better estimate your health care costs. Even if you have primary health insurance, these out-of-pocket expenses can add up quickly.
Aflac doesn’t offer primary health insurance, but we do offer several types of supplemental insurance for individuals and families that can help cover costs your primary plan doesn't fully cover, including:
Chat with an Aflac agent today to explore your coverage options and get a quote.
Get Started
Hospital indemnity insurance can help pay for costs your current plan doesn't cover. Learn what hospital indemnity insurance is and whether it's right for you.
The average cost of health insurance can depend on your age, health, and other factors. Learn how health insurance works and how much it costs on average.
Hospital indemnity insurance can help pay for costs your current plan doesn't cover. Learn what hospital indemnity insurance is and whether it's right for you.
The average cost of health insurance can depend on your age, health, and other factors. Learn how health insurance works and how much it costs on average.
1,2,4 Investopedia - Coinsurance vs. Copays: What's the Difference? Updated April 30, 2025. https://www.investopedia.com/articles/insurance/120816/coinsurance-vs-copay-why-you-need-know-difference.asp. Accessed February 25, 2026.
3,6 Debt.org. Health Insurance Premiums, Deductibles, Copays and Coinsurance. Updated on May 20, 2025. https://www.debt.org/medical/health-insurance-premiums/. Accessed on May 26, 2026.
5 KFF. Average Annual Deductible per Enrolled Employee in Employer-Based Health Insurance for Single and Family Coverage. Updated in 2025. https://www.kff.org/private-insurance/state-indicator/average-annual-deductible-per-enrolled-employee-in-employer-based-health-insurance-for-single-and-family-coverage/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D. Accessed on May 26, 2026.
Content within this article is provided for general informational purposes and is not provided as tax, legal, health, or financial advice for any person or for any specific situation. Employers, employees, and other individuals should contact their own advisers about their situations. For complete details, including availability and costs of Aflac insurance, please contact your local Aflac agent.
Aflac Coverage:
Accident, A37000 series: In Delaware, Policy A371AA & A371BA. In Oklahoma, Policy A37000OK. A38000 series: In Delaware Policies A38100DE – A38300DE & A382OFDE. In Delaware Policies A38100DE – A38300DE & A382OFDE. In Idaho, Policies A38100ID – A38300ID. In Oklahoma A38100OK – A38300OK & A382OFOK. In Virginia, Policies A38100VA – A38300VA & A382OFVA.
Cancer/Specified-Disease, B70000 series: In Delaware, Policies B70100DE, B70200DE & B70300DE. In Idaho, Policies B70100ID, B70200ID & B70300ID. In Oklahoma, Policies B70100OK, B70200OK & B70300OK. 75000 series: In Virginia, policies A75100VA–A75300VA. Cancer insurance is also known as specified disease insurance in some states.
Critical Illness/Specified Health Event, A74000 series: In Delaware, Policies A74100DE, A74200DE, A74300DE. In Idaho, Policies A74100ID, A74200ID, A74300ID. In Oklahoma, Policies A74100OK, A74200OK, A74300OK. In Virginia, Policies A74100VA, A74200VA, A74300VA. A73000 series: In Delaware, Policies A73100DE & A7310HDE. In Idaho, Policies A73100ID & A7310HID. In Oklahoma, Policies A73100OK & A7310HOK. In Virginia, Policy A73100VA & A7310HVA. B71000 series: In Delaware, Policies B71100, B71200, B7130H & B7140H. In Oklahoma, Policies B71100OK & B7110HOK.
Dental, A82000 series: In Delaware, Policies A82100R–A82400R. In Idaho, Policies A82100RID–A82400RID. In Oklahoma, Policies A82100ROK–A82400ROK. In Virginia, Policies A82100RVA–A82400RVA.
Hospital, B40000 series: In Delaware, Policies B40100DE & B4010HDE. In Idaho, Policies B40100ID & B4010HID. In Oklahoma, Policies B40100OK & B4010HOK. In Pennsylvania, Policies B40100PA & B4010HPA. In Virginia, Policies B40100VA & B4010HVA.
Short-Term Disability, A57600 series: In Delaware, Policies A57600DE & A57600LB. In Idaho, Policy A57600IDR. In Oklahoma, Policies A57600OK & A57600LBOK. In Virginia, Policies A57600VA & A57600LBVA.
Vision, VSN series: In Delaware, Policy VSN100. In Idaho, Policy VSN100ID. In Oklahoma, Policy VSN100OKR. In Virginia, Policy VSN100VA.
Aflac coverage is underwritten by American Family Life Assurance Company of Columbus. In New York, Aflac coverage is underwritten by American Family Life Assurance Company of New York.
Tier One Coverage:
Accident, T37000 series:
In Delaware, Policy T37000. In Idaho, Policies T37100ID, T37200ID, & T37300ID. In Oklahoma, Policy T37000OK. In Virginia, Policies T37100VA, T37200VA, T37300VA, T37400VA & T37600VA. Cancer/Specified Disease plans, T70000 series: In Delaware, Policy T70000DE. In Idaho, Policy T70000ID. In Oklahoma T70000OK.
Critical Illness, T71000 series: In Delaware, Policy T71000. In Oklahoma, Policy T71000OK. In Virginia, Policy T71100VA.
Dental, Vision and Hearing: In Delaware, Policy T80000. In Idaho, Policy T80000ID. In Oklahoma, Policy T80000OK. Not available NY or VA. Dental claims are administered by SKYGEN USA, LLC. Vision claims are administered by EyeMed Vision Care, LLC. Hearing claims are administered by Nations Hearing. NOTICE: The coverage offered is not a qualified health plan (QHP) under the Patient Protection and Affordable Care Act (ACA) and is not required to satisfy essential health benefits mandates of the ACA. The coverage provides limited benefits.
Tier One coverage is underwritten by Tier One Insurance Company. Tier One Insurance Company is part of the Aflac family of insurers. In California, Tier One Insurance Company does business as Tier One Life Insurance Company (NAIC 92908).
Coverage/plan levels may not be available in all states, including but not limited to NJ, NM, NY, VA or VT. Benefits/premium rates may vary based on plan selected. Optional riders may be available at an additional cost. Policies and riders may also contain a waiting period. Refer to the exact policy and rider forms for benefit details, definitions, limitations and exclusions.
Aflac WWHQ | Tier One Insurance Company | 1932 Wynnton Road | Columbus, GA 31999
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