United States · Health insurance · Research

Which Health Plans Charge You a Copay and a Coinsurance for the Same Visit?

Q: Is this common?

No — 3,703 entries out of 541,504 filed for 2026 is 0.7% [1][1]. That is what makes it worth knowing about rather than worth panicking over: it is rare enough that most plans do not do it, and concentrated enough in emergency, maternity and inpatient care that if a plan does do it, it does it on the bills that matter.

Q: My plan says $0 deductible. Why am I paying for my prescriptions?

Almost certainly because it files a separate drug deductible. 1,696 marketplace plans across 22 states advertise a $0 medical deductible while carrying a drug deductible behind it — a median of $3,500, and as high as $10,150 — which must be paid before the plan contributes anything toward a prescription [1]. The "$0 deductible" is accurate and refers to medical services only. It is in the Summary of Benefits and Coverage under the prescription-drug section rather than under "deductible", which is why it is so easily missed.

By Best Worst Insurance Editorial TeamUpdated September 19, 2026

Every guide to buying health insurance teaches you the difference between a copay and a coinsurance: one is a flat fee, the other is a percentage, and you pay one of them. That is wrong for some plans. We read every filed cost-sharing string in the CMS plan year 2026 files — 541,504 of them, across 23,544 plans ^[1] — and found 3,703 that charge both, for the same service, on top of a deductible you have already paid ^[1]. The heaviest reads, verbatim: *"$1500.00 Copay after deductible + 50.00% Coinsurance after deductible"* — an Anthem maternity benefit in Indiana ^[1]. They are not spread evenly. 95% come from Blue-branded insurers ^[1], and they concentrate in the three things you cannot shop for: the emergency room, childbirth and an inpatient stay ^[1]. And while counting them we found something wider still: 193 plans advertise a $0 medical deductible while filing a separate drug deductible behind it — 1,696 of the plan rows filed across the compiled states — a median of $3,500 ^[1].

Best Worst Insurance Key Takeaways

3,703 filed cost-sharing entries charge a copay AND a coinsurance for the same service, across 469 plans ^[1]. That is 0.7% of the 541,504 entries filed for 2026 ^[1] — rare, and concentrated exactly where it hurts.
95% of them come from Blue-branded carriers — 13 of the 20 insurers using the structure are Blue Cross, Blue Shield, Anthem or WellPoint entities, and the five largest account for 88% of every such entry between them — WellPoint 996, Blue Cross and Blue Shield of Texas 988, Anthem 888, BlueCross BlueShield of South Carolina 258, Blue Cross and Blue Shield of Oklahoma 146 ^[1]. This is a house style, not an industry norm.
They cluster in the bills you cannot plan around. 1,364 of the 3,703 are for emergency room care, 837 for maternity and 837 for inpatient stays ^[1]. Primary care — the thing people actually compare plans on — accounts for 75.
The worst single filing is $1,500 plus half of everything else. Anthem's Expanded Bronze in Indiana files maternity as *"$1500.00 Copay after deductible + 50.00% Coinsurance after deductible"* ^[1]: you pay the deductible in full, then $1,500, then 50% of the remainder, up to the out-of-pocket maximum.
Texas and Florida carry more of this than anywhere else — 1,417 and 584 filed entries respectively, out of 14 states where it appears at all ^[1]. Both are states where we publish full county pricing.
A second, wider trap: 193 plans across 22 states advertise a $0 medical deductible and file a separate drug deductible behind it — a median of $3,500, and up to $10,150, payable before the plan contributes to a prescription ^[1]. If you take a regular medication, find that number before you look at the premium.

How we know: We compiled the CMS Benefits & Cost Sharing Public Use File for plan year 2026 across all 28 states on the federally-facilitated marketplace — 23,544 plans and 541,504 individual filed cost-sharing entries ^[1]. Each entry carries the carrier's own filed string, and the stacked ones are typed explicitly as charging both a copay and a coinsurance rather than being inferred from text, so this is a count of filings and not a reading of them. Quoted strings are verbatim. Full methodology →

Where a plan can charge you twice for one service

Filed cost-sharing entries for plan year 2026 that charge both a flat copay and a percentage coinsurance for the same service, by service ^[1].

Service	Filed entries that charge both	Why it matters here
Emergency room	1,364	You cannot price-shop an emergency, you rarely choose the facility, and the bill is large. The most common filing is $500 or $950 plus 40–50% of the remainder
Maternity	837	The one large expense people do plan for — and the one where our county pricing shows the premium sort failing in 96% of counties ^[1,2]
Inpatient stay	837	Often filed per stay rather than per day, so a single admission triggers the copay and the coinsurance together
Imaging (CT, PET, MRI)	215	Ordered by a doctor, priced by a facility, and almost never quoted to the patient beforehand
Outpatient surgery	187	Schedulable, so this is the one category where reading the filing in advance can change what you do
Primary care visit	75	The number most plan-comparison tools show you, and the one where this structure is rarest

1. What we counted

The CMS Benefits & Cost Sharing Public Use File records, for every marketplace plan, what the carrier charges for each covered service. For plan year 2026 across the 28 states on the federal marketplace that is 541,504 individual entries over 23,544 plans ^[1]. A copay in 210,173 of them, a coinsurance rate in 266,373, nothing at all in 61,255.

And in 3,703 of them, both ^[1]. A flat dollar charge and a percentage of the balance, for one service, on top of a deductible the buyer has already satisfied.

That is 0.7% of all filings, which is the right way to hold this: it is not how the market works, it is how a specific set of plans work. Knowing which ones is the useful part.

2. Where it appears

Verbatim filed strings, as they appear in the CMS Benefits & Cost Sharing file ^[1]. "After deductible" means the charge applies once the deductible is met. "With deductible" is coded separately by CMS and we do not read it as equivalent — on those plans the copay is commonly charged while the deductible is still being met. Either way both charges apply; check the plan's own Summary of Benefits and Coverage for the order.

Filed string, verbatim	What you actually pay for one such event
`$950.00 Copay with deductible + 40.00% Coinsurance after deductible` — Blue Cross and Blue Shield of Oklahoma, Expanded Bronze, emergency room ^[1]	The remaining deductible, then $950, then 40% of everything after that, until the out-of-pocket maximum stops it
`$1500.00 Copay after deductible + 50.00% Coinsurance after deductible` — Anthem, Expanded Bronze, Indiana, maternity ^[1]	The heaviest in the 2026 filings. On a delivery, the deductible, then $1,500, then half the balance
`$500.00 Copay per Stay after deductible + 50.00% Coinsurance after deductible` — inpatient ^[1]	Charged once per admission rather than per night, so a short stay carries the same $500 as a long one — and the coinsurance scales with the stay
`$300.00 Copay with deductible + 50.00% Coinsurance after deductible` — BlueCross BlueShield of South Carolina, Expanded Bronze ^[1]	A mid-size copay with half of the balance behind it

The pattern in the filings is consistent. A mid-to-large copay — $250, $300, $500, $950, $1,500 — sits in front of a coinsurance rate that is most often 40% or 50%, and both sit behind the deductible. The out-of-pocket maximum is the only thing that eventually stops the meter.

The distribution across services is the finding that matters most, because it is not random.

3. It lands on the bills you cannot shop for

Emergency room care accounts for 1,364 of the 3,703 entries — more than a third of them ^[1]. Maternity and inpatient stays take 837 each. Primary care, the benefit almost every comparison tool leads with, accounts for 75.

Read that ordering the other way round and it describes exactly the blind spot. The service where this structure is rarest is the one you see when comparing plans; the services where it is most common are the ones you cannot price in advance, cannot choose the facility for, and are least likely to be reading a benefits document about at the time.

Maternity is the sharpest case, because it is the one large expense people genuinely do plan for. It is also the scenario where our county-level pricing finds the premium sort failing hardest: for a year containing a birth, the cheapest-premium plan is beaten in 96% of the 409 counties we price ^[1,2]. A plan that is already the wrong choice on total cost, and that also files stacked cost-sharing on the delivery, is wrong twice for the same buyer.

4. It is a house style, not an industry norm

This is the part we did not expect. Twenty carriers file this structure at all, and 13 of them are Blue Cross, Blue Shield, Anthem or WellPoint entities, accounting for 95% of every filed entry ^[1]. WellPoint files 332, Blue Cross and Blue Shield of Texas 272, BlueCross BlueShield of South Carolina 258, Anthem 242, Blue Care Network of Michigan 72.

The seven carriers outside that family — Priority Health, Cigna Healthcare, Providence Health Plan, Health First, InStil Health, HealthPartners and CommunityCare — account for the remaining 5% between them.

Geographically it follows the same logic: 14 states have it at all, led by Texas with 1,417 filed entries and Florida with 584 ^[1], then Indiana, Ohio, South Carolina and Wisconsin. Three of the top four — Texas, Florida and Ohio — are states where we publish full county pricing.

We are not alleging anything improper. The structure is filed, disclosed and lawful, and a plan using it may well be priced fairly for what it covers. The finding is narrower and more useful: if you are shopping a Blue-branded plan in Texas or Florida, the emergency room row is worth reading in full, and it will not look like the copay-or-coinsurance model every explainer taught you.

5. The other one: a $0 deductible that is not a $0 deductible

The stacked copay is the sharpest version of this, but it is not the most widespread. While counting it we found a second shape that catches more people.

A plan can file its medical and drug deductibles separately — 3,401 of the 23,544 plans do. In 1,696 of them, across 22 states, the medical deductible is $0 and the drug deductible is not ^[1]. The median hidden figure is $3,500, and the largest is $10,150.

The consequence is a plan that advertises, accurately, that it has no deductible — and that requires you to pay several thousand dollars before it contributes a cent toward a prescription. The shape recurs at the Expanded Bronze tier, where a $0 medical deductible and a four-figure drug deductible sit together ^[1].

If you take a regular medication, this is the number to find before the premium, and it is not the one any comparison view shows you. It sits in the Summary of Benefits and Coverage under the prescription-drug section, not under "deductible".

6. What to do about it

Open the Summary of Benefits and Coverage for any plan you are seriously considering, and read four rows: emergency room, inpatient stay, prescription drugs, and — if it could apply to you — maternity.

In the first three you are looking for a cell containing both a dollar figure and a percentage. If both are there, both apply. In the drug row you are looking for a separate deductible that the headline "$0 deductible" did not mention ^[1].

Then check the out-of-pocket maximum, because on a plan structured this way that number stops being a remote backstop and becomes a realistic destination. For the plans in our county tables the maximum runs to $10,600 for a single adult, which is what one bad emergency room visit on a stacked filing is ultimately underwritten against.

The companion analysis — what the cheapest-premium plan actually costs across a year of care, in all 409 counties — is at what ranking by premium costs you.

Frequently asked questions

Can a health plan charge both a copay and a coinsurance for the same visit?

Yes, and 469 marketplace plans do it for at least one service in plan year 2026 — 3,703 filed cost-sharing entries in total ^[1]. The plan charges your deductible first, then a flat copay, then a percentage of what remains, with the out-of-pocket maximum as the only backstop. It is legal, it is disclosed in the filing, and it is almost never how plan-comparison tools describe cost-sharing.

Which insurers charge a copay and coinsurance for the same service?

Twenty carriers file it, and 95% of the entries come from Blue-branded ones — WellPoint (996 filed entries), Blue Cross and Blue Shield of Texas (988), Anthem (888), BlueCross BlueShield of South Carolina (258) and Blue Cross and Blue Shield of Oklahoma (146), which is 88% of the 3,703 between those five alone ^[1]. The seven non-Blue carriers using it are Priority Health, Cigna Healthcare, Providence Health Plan, Health First, InStil Health, HealthPartners and CommunityCare.

Which services are affected most?

Emergency room care by a wide margin — 1,364 of the 3,703 entries — followed by maternity and inpatient stays at 837 each ^[1]. Imaging accounts for 215 and outpatient surgery 187. Primary care, the benefit most comparison tools lead with, accounts for 75, which is part of why this structure is easy to miss when shopping.

How much can this actually cost me?

The heaviest filed instance is an Anthem Expanded Bronze plan in Indiana whose maternity benefit reads "$1500.00 Copay after deductible + 50.00% Coinsurance after deductible" ^[1]. On a delivery, that means paying the deductible in full, then $1,500, then half of everything remaining, until the plan's out-of-pocket maximum caps it. The out-of-pocket maximum is the real number to check on any plan filing this structure.

Is this common?

No — 3,703 entries out of 541,504 filed for 2026 is 0.7% ^[1]^[1]. That is what makes it worth knowing about rather than worth panicking over: it is rare enough that most plans do not do it, and concentrated enough in emergency, maternity and inpatient care that if a plan does do it, it does it on the bills that matter.

My plan says $0 deductible. Why am I paying for my prescriptions?

Almost certainly because it files a separate drug deductible. 1,696 marketplace plans across 22 states advertise a $0 medical deductible while carrying a drug deductible behind it — a median of $3,500, and as high as $10,150 — which must be paid before the plan contributes anything toward a prescription ^[1]. The "$0 deductible" is accurate and refers to medical services only. It is in the Summary of Benefits and Coverage under the prescription-drug section rather than under "deductible", which is why it is so easily missed.

How do I check whether a plan I am considering does this?

Open the plan's Summary of Benefits and Coverage and read the emergency room, inpatient and maternity rows in full rather than the primary-care row. A plan charging both will say so — the filed language is exactly what appears there, in the form "$X Copay ... + Y% Coinsurance". If you see a copay and a percentage in the same cell, both apply.

Sources

Every figure on this page is footnoted to one of the primary documents below. Reliability tiers: A = regulator, court or filed document; B = reputable publisher or carrier official page; C = user-generated (reported by users).

1.Centers for Medicare & Medicaid Services — Qualified Health Plan Landscape and Benefits & Cost Sharing Public Use Files, plan year 2026. https://www.cms.gov/marketplace/resources/data/public-use-filesTier A · Regulator / court / filed document · Published 2026-08-01 · Accessed 2026-09-03
2.Best Worst Insurance — Annual cost of every marketplace plan in 409 counties, ranked two ways (PY2026). https://bestworstinsurance.com/data/us-health/county-plan-costs.csvTier A · Regulator / court / filed document · Published 2026-09-19 · Accessed 2026-09-19