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Deductibles, copays and coinsurance are a few factors that determine how a health insurance policy works. More specifically, these facets determine how costs are divided by the insurance company and the insurer. Let’s dive deeper into what deductibles, copays, and coinsurance are, along with some differences between them.
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Let’s define how deductibles, copays, and coinsurance work in a traditional health insurance policy:
A deductible is a certain dollar amount the policyholder must pay before most health insurance benefits kick in.1 Deductibles vary depending on the plan you choose.
A copay is a set dollar amount that the policyholder agrees to pay for various kinds of care and treatment—like doctor visits, preventative care, and prescriptions.1
Coinsurance is the percentage a policyholder pays for health services after the deductible has been met.1
Sometimes, how deductibles, copays, and coinsurance are structured can leave policyholders with thousands of dollars expected to be paid out-of-pocket. Aflac doesn’t offer primary health insurance plans, but we do offer supplemental insurance coverage that can help pay outstanding costs, like deductibles, copays and coinsurance.
There are a handful of differences between copays and deductibles. As we learned earlier, a deductible is a pre-determined value that must be met before most policy benefits become available. Deductibles can fall somewhere in the hundreds or thousands of dollars.
On the other hand, copays are usually (relatively) inexpensive and apply to your health services. These fees remain static regardless of if you’ve met the deductible or not.1 Copays can help make office visits, preventative care and other health care more affordable compared to paying completely out-of-pocket without most health insurance.
Don’t wait until it’s too late. Help cover yourself and your family with coverage from Aflac.
Get StartedThe difference between copays and coinsurance is how the policyholder agrees to pay for a portion of services. As we discussed earlier, copays are specific, predetermined dollar amounts, while coinsurance is calculated as a percentage of the total cost of services.1
Copay structures are determined by the type of health care you receive and apply, even if you haven’t met your deductible.1 For example, the copay may be lower for preventative care than for an urgent care visit. On the other hand, coinsurance can be broader and only applies after you’ve met the deductible.1
The cost breakdown for coinsurance could look like having you pay 20% of services while your insurance company pays the other 80%. This payment structure only applies until you meet your maximum out-of-pocket limit.1 If you reach this value, your health insurance company will pay for any remaining treatments within the coverage year. It’s important not to confuse your deductible with the maximum out-of-pocket limit.
The difference between deductibles and coinsurance is related to when payments are due and how they accumulate. Coinsurance benefits only kick in after the deductible has been paid in full.1
When figuring out how much you’ll pay for health care, it’s important to understand how deductibles, copays, and coinsurance work. Now that you know the differences between these types of costs, you may determine where there are potential areas for additional coverage. Luckily, Aflac offers a variety of specific supplemental insurance plans to help cover those costs.
We offer supplemental insurance plans for vision, hospital, cancer, accident, short-term disability, and critical illness care. Whether you know the specific health care category you need better support in or are unsure of what kind of supplemental coverage to get, we recommend chatting with an agent today to see how Aflac may be able to help make your care more affordable.
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1 Investopedia - Coinsurance vs. Copays: What's the Difference? Updated April 30, 2025. https://www.investopedia.com/articles/insurance/120816/coinsurance-vs-copay-why-you-need-know-difference.asp. Accessed February 25, 2026.
2 Forbes - What Is a Health Insurance Deductible? Updated February 10, 2025. https://www.forbes.com/advisor/health-insurance/what-is-a-health-insurance-deductible/. Accessed February 25, 2026.
Content within this article is provided for general informational purposes and is not provided as tax, legal, health, or financial advice for any person or for any specific situation. Employers, employees, and other individuals should contact their own advisers about their situations. For complete details, including availability and costs of Aflac insurance, please contact your local Aflac agent.
Aflac Coverage:
Accident, A37000 series: In Delaware, Policy A371AA & A371BA. In Oklahoma, Policy A37000OK. A38000 series: In Delaware Policies A38100DE – A38300DE & A382OFDE. In Delaware Policies A38100DE – A38300DE & A382OFDE. In Idaho, Policies A38100ID – A38300ID. In Oklahoma A38100OK – A38300OK & A382OFOK. In Virginia, Policies A38100VA – A38300VA & A382OFVA.
Cancer/Specified-Disease, B70000 series: In Delaware, Policies B70100DE, B70200DE & B70300DE. In Idaho, Policies B70100ID, B70200ID & B70300ID. In Oklahoma, Policies B70100OK, B70200OK & B70300OK. 75000 series: In Virginia, policies A75100VA–A75300VA. Cancer insurance is also known as specified disease insurance in some states.
Critical Illness/Specified Health Event, A74000 series: In Delaware, Policies A74100DE, A74200DE, A74300DE. In Idaho, Policies A74100ID, A74200ID, A74300ID. In Oklahoma, Policies A74100OK, A74200OK, A74300OK. In Virginia, Policies A74100VA, A74200VA, A74300VA. A73000 series: In Delaware, Policies A73100DE & A7310HDE. In Idaho, Policies A73100ID & A7310HID. In Oklahoma, Policies A73100OK & A7310HOK. In Virginia, Policy A73100VA & A7310HVA. B71000 series: In Delaware, Policies B71100, B71200, B7130H & B7140H. In Oklahoma, Policies B71100OK & B7110HOK.
Dental, A82000 series: In Delaware, Policies A82100R–A82400R. In Idaho, Policies A82100RID–A82400RID. In Oklahoma, Policies A82100ROK–A82400ROK. In Virginia, Policies A82100RVA–A82400RVA.
Hospital, B40000 series: In Delaware, Policies B40100DE & B4010HDE. In Idaho, Policies B40100ID & B4010HID. In Oklahoma, Policies B40100OK & B4010HOK. In Pennsylvania, Policies B40100PA & B4010HPA. In Virginia, Policies B40100VA & B4010HVA.
Short-Term Disability, A57600 series: In Delaware, Policies A57600DE & A57600LB. In Idaho, Policy A57600IDR. In Oklahoma, Policies A57600OK & A57600LBOK. In Virginia, Policies A57600VA & A57600LBVA.
Vision, VSN series: In Delaware, Policy VSN100. In Idaho, Policy VSN100ID. In Oklahoma, Policy VSN100OKR. In Virginia, Policy VSN100VA.
Aflac coverage is underwritten by American Family Life Assurance Company of Columbus. In New York, Aflac coverage is underwritten by American Family Life Assurance Company of New York.
Tier One Coverage:
Accident, T37000 series:
In Delaware, Policy T37000. In Idaho, Policies T37100ID, T37200ID, & T37300ID. In Oklahoma, Policy T37000OK. In Virginia, Policies T37100VA, T37200VA, T37300VA, T37400VA & T37600VA. Cancer/Specified Disease plans, T70000 series: In Delaware, Policy T70000DE. In Idaho, Policy T70000ID. In Oklahoma T70000OK.
Critical Illness, T71000 series: In Delaware, Policy T71000. In Oklahoma, Policy T71000OK. In Virginia, Policy T71100VA.
Dental, Vision and Hearing: In Delaware, Policy T80000. In Idaho, Policy T80000ID. In Oklahoma, Policy T80000OK. Not available NY or VA. Dental claims are administered by SKYGEN USA, LLC. Vision claims are administered by EyeMed Vision Care, LLC. Hearing claims are administered by Nations Hearing. NOTICE: The coverage offered is not a qualified health plan (QHP) under the Patient Protection and Affordable Care Act (ACA) and is not required to satisfy essential health benefits mandates of the ACA. The coverage provides limited benefits.
Tier One coverage is underwritten by Tier One Insurance Company. Tier One Insurance Company is part of the Aflac family of insurers. In California, Tier One Insurance Company does business as Tier One Life Insurance Company (NAIC 92908).
Coverage/plan levels may not be available in all states, including but not limited to NJ, NM, NY, VA or VT. Benefits/premium rates may vary based on plan selected. Optional riders may be available at an additional cost. Policies and riders may also contain a waiting period. Refer to the exact policy and rider forms for benefit details, definitions, limitations and exclusions.
Aflac WWHQ | Tier One Insurance Company | 1932 Wynnton Road | Columbus, GA 31999
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