These are the five numbers that decide what a plan really costs you.

  • Premium is what you pay every month to keep the plan, whether you use it or not.
  • Deductible is what you pay for covered care before the plan starts paying. With a $2,000 deductible, you cover the first $2,000.
  • Copay is a flat amount for a specific service, like $30 for an office visit.
  • Coinsurance is a percentage of the bill after your deductible is met. At 20% coinsurance on a $100 service, you pay $20.
  • Out-of-pocket maximum is your ceiling. Once you hit it, the plan pays 100% of covered in-network care for the rest of the year.

For 2027, federal law caps out-of-pocket costs at $12,000 for an individual and $24,000 for a family. Monthly premiums, out-of-network care, and anything the plan does not cover do not count toward that ceiling.