When shopping for your health plan, you’ll choose between two types: copayment plans and deductible/coinsurance plans. The plan you choose will affect how you’ll pay for care at the doctor, pharmacy or hospital.

Copayments

A fixed dollar amount that you pay for a covered service at the time you receive it. Plans with copays tend to be more expensive. But, you’ll know the cost of the visit before you go.

Example: Your plan charges a $20 copay for a regular doctor visit. This visit will only cost your $20 copay.

Deductibles

The amount you owe for covered health care before your health insurance company starts to pay.
Example: You have a plan with a $3,000 deductible.  You’ve paid $2,000 toward it, and just had an MRI that costs $1,500. You will pay $1000 to reach your deductible and a portion of the remaining $500 based on your coinsurance percentage.

Coinsurance

Your share of costs for health care expenses based on a percentage of those costs. After you’ve met your deductible, you may be charged coinsurance for health care services. The cost of the service is split between you and the insurance company.

Example: You get a $100 bill for a chest X-ray and you have a 30% coinsurance amount, you’ll need to pay $30 and the insurance company will pay the rest.

To help make health insurance more affordable, the federal government offers financial assistance, in the form of subsidies, to individuals and families who qualify based on income and household size.

There are two types of subsidies: Advanced Premium Tax Credit (APTC) and Cost Sharing Reductions (CSRs).