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Copay vs Coinsurance Calculator

Enter the service cost, copay, coinsurance rate and deductible to compare your share.

How it is calculated

The tool prices one service under two plan types. In both, you first pay the remaining deductible, up to the cost of the service: deductible part = min(deductible, cost), and the rest is remainder = cost − deductible part. Copay plan: you pay = deductible part + min(copay, remainder). Coinsurance plan: you pay = deductible part + remainder × coinsurance% ÷ 100. The third figure is coinsurance − copay, so a positive difference means the copay plan is cheaper and a negative one (shown with a minus sign) means coinsurance is cheaper. The deductible field is the amount still unmet and is optional (blank counts as 0). Amounts are in US dollars. Negative values in any field give no result. There is no out-of-pocket maximum in the calculation, and it covers a single service, not a whole year.

Worked example

A procedure is billed at 1,200. You still owe 500 of your deductible. Copay is 40 and coinsurance is 20%. Deductible part = min(500, 1,200) = 500; remainder = 700. Copay plan: 500 + min(40, 700) = $540.00. Coinsurance plan: 500 + 700 × 20% = 500 + 140 = $640.00. Difference = 640 − 540 = $100.00 in favour of the copay plan. For a cheap 150 visit with no deductible left, the same plans give $40.00 versus $30.00, and coinsurance wins by $10.00.

Try this example →

Common mistakes

  • Entering the full yearly deductible instead of the part you have not yet paid. Only the unmet amount belongs in that field.
  • Entering the coinsurance as the share the insurer pays. If the plan pays 80%, your coinsurance is 20.
  • Comparing on a single cheap visit and generalising. Coinsurance can win on small bills and lose heavily on large ones; test the bills you expect.
  • Forgetting that the tool has no out-of-pocket maximum. On a very expensive service a real plan would stop charging you at its limit, so the coinsurance figure here can be too high.
  • Ignoring the premium. A plan with cheaper cost-sharing can still cost more overall once monthly premiums are added.

Sources

About this calculator

A copay is a flat fee you pay for a covered service regardless of its actual cost, while coinsurance is a percentage of the service's cost you pay after meeting your deductible — so your out-of-pocket amount under coinsurance scales with how expensive the service turns out to be, while a copay doesn't. This calculator compares both paths for the same service. In both, any remaining deductible you enter is paid first; after that, the copay path adds your flat copay (never more than the cost left) and the coinsurance path adds the coinsurance rate × the cost above the deductible. It does not apply an out-of-pocket maximum.

Which option costs less depends heavily on the service price relative to the deductible and coinsurance rate — coinsurance can be cheaper for low-cost visits but far more expensive for a costly procedure or hospitalization. Patients comparing insurance plans during open enrollment, and HR/benefits administrators explaining plan options to employees, use this comparison to understand which cost-sharing structure is more favorable for their typical healthcare usage.

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