Which statement correctly defines co-pay, deductible, and coinsurance?

• A. Deductible is a fixed patient payment at each visit; coinsurance is a set fee per service
• B. Co-pay is a fixed patient payment; deductible is the amount paid before coverage starts; coinsurance is a percentage patient pays after meeting deductible
• C. Coinsurance is a fixed patient payment; co-pay is a percentage; deductible is the maximum out-of-pocket
• D. Co-pay, deductible, and coinsurance all mean the same thing

Answer: (B)

Understanding how cost-sharing works in health insurance helps clarify these terms. A co-pay is a fixed amount you pay for a service at the time you receive it, such as a $30 visit that you pay whether the total bill is larger or smaller. The deductible is the total amount you must pay out of pocket before the insurance starts contributing to covered services in the plan year. Coinsurance is the percentage of the costs you pay after the deductible has been met, meaning you share a portion of the bill with the insurer based on a set percent.

This combination is what the correct statement captures: a fixed co-pay, a deductible that must be met before coverage kicks in, and a coinsurance percentage applied after the deductible is satisfied. For example, with a $1,000 deductible and 20% coinsurance, you pay up to $1,000 yourself, and once that’s met, you pay 20% of subsequent allowed charges while the insurer pays the remaining 80% (until you reach the out-of-pocket maximum). The other options mix up these roles: deductibles aren’t fixed per visit, coinsurance isn’t a fixed fee per service, and deductible isn’t the maximum out-of-pocket.