A fixed amount you pay each time you get a specific service. For example, if your copay is $25, you pay $25 each time you visit your provider.

What is a deductible?

The amount you pay each year before your insurance starts sharing the cost of care. With a $1,500 deductible, you pay the first $1,500 of covered care yourself before insurance kicks in.

After you hit your deductible, coinsurance is the percentage of the bill you still pay. If insurance covers 80%, you cover 20% — a $1,000 procedure after your deductible is met still costs you $200.

What is an Explanation of Benefits (EOB)?

A summary from insurance explaining how your claim was processed. It shows what your provider charged, what insurance paid, and what you may owe. It is not a bill.

The Health Clarity Project

Health Insurance: Decoded

Name: Understanding Medical Bills: A Simple Guide to Health Insurance, Costs, and What You Actually Owe
Author: The Health Clarity Project
ISBN: 9798184752037

Plain-English explanations of EOBs, deductibles, copays, and every confusing line on your medical bill, so you always know what you owe, and why.

Get the guide Follow @healthclarityproject

A real scenario: EOB Says One Thing, Your Bill Says Another

Explanation of Benefits

Billed$1,240

Plan Paid$1,240

Patient responsibility

Medical Bill

Billed$1,240

Plan Paid$920

Amount due

$320

Both can be. An EOB isn't a bill. It can be confusing because your EOB and medical bill serve two different purposes. Your EOB shows how your insurance processed the claim, while your provider's bill shows what they're asking you to pay. If the numbers don't match, don't panic. Some steps to take would be to understand if you met your deductible, and request an itemized bill so you can check exactly what you were charged for. In any case, always compare your EOB to your bill before paying.

Glossary

Four words insurance companies assume you already know.

Tap a term to learn more.

Copay

A fixed amount you pay each time you get a specific service.

In practice: If your copay is $25, you pay $25 each time you visit your provider.

The guide

Understanding Medical Bills

A no-jargon walkthrough of how health insurance actually works, built for anyone who's ever stared at a bill and thought "this doesn't make sense".

Translate the core terms : copay, deductible, coinsurance, and everything else your plan assumes you already know.
Read a bill and an EOB side by side and understand the difference.
Recognize common CPT codes that show up on statements and claims.
Includes a personal organizer to track your important healthcare information.

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Helpful explanations

Short, plain-English breakdowns of the parts of healthcare no one ever explains.

Got a surprise medical bill?

Here's why it happens

You've met your deductible. So why are you still paying?

It could be coinsurance

What is a copay?

30-second breakdown

My insurance says I owe $0. My bill says $320.

Which one is right?

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Health Insurance: Decoded

Four words insurance companies assume you already know.

Understanding Medical Bills

Helpful explanations

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Healthcare is confusing, but we're here to simplify those confusing parts for you and make it more understandable, one explanation at a time.