A deductible is the amount you pay out of pocket for covered medical services before your insurance company starts sharing the cost. For example, if your plan has a $2,000 deductible, you pay the first $2,000 of covered medical expenses each year. After that, depending on your plan, your insurance company pays a percentage of the remaining $3,000. Your share of that remaining amount is your coinsurance. If your plan has 80/20 coinsurance after the deductible, you pay $600 and insurance pays $2,400. You keep paying your share until you hit your plan's out-of-pocket maximum, at which point insurance covers 100% of covered in-network costs for the rest of the year.
For 2026, the out-of-pocket maximum for an individual plan is $10,600. For family plans, it's $21,200. This is the absolute ceiling on what you'll spend on covered in-network care in a single plan year.
Not all services require you to meet your deductible first
- Deductible: The amount you pay out of pocket for covered services before your insurance starts paying
- Copay: A fixed dollar amount you pay for a specific service, like a doctor visit, regardless of whether you've met your deductible
- Coinsurance: Your share of costs after you've met your deductible, expressed as a percentage (for example, you pay 20%, the plan pays 80%)
- Out-of-pocket maximum: The most you'll ever pay in a plan year. Once you hit this limit, your insurance covers 100% of covered costs. For 2026, the cap is $10,600 for individuals and $21,200 for families.
- Premium: Your monthly payment to keep the plan active, separate from your deductible
When comparing plans, don't focus only on the deductible. A plan with a $500 monthly premium and a $7,000 deductible may cost more overall than a plan with a $650 premium and a $1,500 deductible, depending on how often your family needs care. Choosing the right plan means looking at the total picture.
Want help comparing deductibles and out-of-pocket costs across plans? Call us at (305) 330-1277 or See your plan options.
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