How are co-payments, deductibles, and co-insurances calculated?


Deductibles, co-insurance, and co-pays are calculated based on your health insurance plan and the negotiated price that the insurance company and the health care provider agree the provider will be reimbursed for. These amounts can vary considerably among different insurance companies and policies.

The deductible will be paid first, followed by co-insurance. Co-pays are handled separately from the deductible and the co-insurance, apply to specific services, and are paid at the time service is received. For example, if you have a $15 co-pay for pharmacy and a $100 deductible, you would pay the entire cost of the prescription until you have spent $100 and then you would be charged the $15 co-pay. Both deductibles and co-pays are applied to out-of-pocket maximum.