How Do Deductibles, Coinsurance and Copays Work?
You and Blue Cross Blue Shield of Michigan share in your health care expenses. Deductibles, coinsurance and copays are all examples of the portion you pay.
Your insurance deductible is the amount you pay for health care services before your health insurance begins to pay.
How it works: If your health plan’s deductible is $1,500, you’ll pay 100% of eligible health care expenses until the bills total $1,500. After that, you share the cost with your health plan by paying coinsurance.
Different things affect your premium. That’s the amount you pay each month to maintain your health care coverage.
How many people are on your plan, the type of health plan and network size all lower or raise your premium. So does your health plan’s deductible.
In most cases, the higher a health plan’s deductible, the lower the premium. When you’re willing to pay more up front when you need care, you save on what you pay each month.
Some people would rather have a smaller premium, and pay more up front for care as they go. It can make your expenses less predictable, since you never know when you might end up with a lot of medical bills.
The lower a health plan’s deductible, the higher the premium. You’ll pay more each month, but your health plan will start sharing the costs sooner because you’ll reach your deductible faster.
Some people like knowing that when they need their insurance, they won’t have to come up with a large sum of money before their health plan starts helping with the cost. So they’d rather have a higher premium, but a lower deductible.
Coinsurance is your share of the costs of a health care service. It's usually figured as a percentage of the amount we allow to be charged for services. You start paying coinsurance after you've paid your health plan's deductible.
How it works: You’ve paid $1,500 in health care expenses and met your deductible. When you go to the doctor, instead of paying all costs, you and your health plan share the cost. For example, your health plan pays 70%. The 30% you pay is your coinsurance.
A copay is a fixed amount you pay out of pocket for a health care service, usually when you receive the service. The amount can vary by the type of service.
How it works: Your health plan determines what your copay is for different types of services, and when you have one. You may have a copay before you’ve finished paying toward your deductible. You may also have a copay after you pay your deductible, and when you owe coinsurance.
Your member ID card may list copays for some visits. You can also log in to your member account or use the Blue Cross Blue Shield of Michigan mobile app to see your health plan’s copays.
If you don't have an online account, you can register for one.
Health plans with tiered copays connect the amount you pay to the type of care you receive. If your health plan offers tiered copays, the lowest copays will be for office visits to a primary care provider, physician’s assistant or nurse practitioner.
If you need to visit urgent care or see a specialist like a cardiologist or an immunologist, your copay will be a little higher. The most expensive copays will come when you visit the emergency room.
Your insurance deductible is the amount you pay for health care services before your health insurance begins to pay.
How it works: If your health plan’s deductible is $1,500, you’ll pay 100% of eligible health care expenses until the bills total $1,500. After that, you share the cost with your health plan by paying coinsurance.
Different things affect your premium. That’s the amount you pay each month to maintain your health care coverage.
How many people are on your plan, the type of health plan and network size all lower or raise your premium. So does your health plan’s deductible.
In most cases, the higher a health plan’s deductible, the lower the premium. When you’re willing to pay more up front when you need care, you save on what you pay each month.
Some people would rather have a smaller premium, and pay more up front for care as they go. It can make your expenses less predictable, since you never know when you might end up with a lot of medical bills.
The lower a health plan’s deductible, the higher the premium. You’ll pay more each month, but your health plan will start sharing the costs sooner because you’ll reach your deductible faster.
Some people like knowing that when they need their insurance, they won’t have to come up with a large sum of money before their health plan starts helping with the cost. So they’d rather have a higher premium, but a lower deductible.
Coinsurance is your share of the costs of a health care service. It's usually figured as a percentage of the amount we allow to be charged for services. You start paying coinsurance after you've paid your health plan's deductible.
How it works: You’ve paid $1,500 in health care expenses and met your deductible. When you go to the doctor, instead of paying all costs, you and your health plan share the cost. For example, your health plan pays 70%. The 30% you pay is your coinsurance.
A copay is a fixed amount you pay out of pocket for a health care service, usually when you receive the service. The amount can vary by the type of service.
How it works: Your health plan determines what your copay is for different types of services, and when you have one. You may have a copay before you’ve finished paying toward your deductible. You may also have a copay after you pay your deductible, and when you owe coinsurance.
Your member ID card may list copays for some visits. You can also log in to your member account or use the Blue Cross Blue Shield of Michigan mobile app to see your health plan’s copays.
If you don't have an online account, you can register for one.
Health plans with tiered copays connect the amount you pay to the type of care you receive. If your health plan offers tiered copays, the lowest copays will be for office visits to a primary care provider, physician’s assistant or nurse practitioner.
If you need to visit urgent care or see a specialist like a cardiologist or an immunologist, your copay will be a little higher. The most expensive copays will come when you visit the emergency room.