What Are Deductibles and Co-Payments?
Health insurance terminology can be confusing, especially for international students navigating a foreign healthcare system for the first time. Understanding deductibles and co-payments is key to avoid unexpected medical bills and choose the right insurance plan.
These cost-sharing mechanisms determine how much you pay out of pocket when you receive medical care, and they vary significantly between countries and insurance plans.
Key Terms Explained
Deductible (Selbstbeteiligung)
A deductible is the amount you must pay out of your own pocket before your insurance starts covering costs. Think of it as a threshold.
Example: If your plan has a €500 deductible:
- You visit the doctor and the bill is €200 → You pay €200 (still under deductible)
- Next visit costs €400 → You pay €300 (reaching the €500 deductible), insurance covers the remaining €100
- After that, insurance kicks in for future claims
Key points:
- Higher deductible = lower monthly premium (and vice versa)
- The deductible usually resets every year
- Some services (like preventive care) may be exempt from the deductible
Co-Payment (Zuzahlung)
A co-payment (co-pay) is a fixed amount you pay each time you receive a specific service, even after meeting your deductible.
Example:
- Doctor visit: €20 co-pay
- Specialist visit: €40 co-pay
- Prescription medication: €10 co-pay
- Emergency room: €100 co-pay
You pay the co-pay, and insurance covers the rest.
Co-Insurance (Mitversicherung)
Co-insurance is a percentage of the cost you pay after meeting your deductible.
Example with 80/20 co-insurance:
- You’ve met your deductible
- Hospital bill: €5,000
- Insurance pays 80% = €4,000
- You pay 20% = €1,000
Out-of-Pocket Maximum (Höchstgrenze)
The maximum amount you’ll pay in a year before insurance covers 100% of costs. This is your financial safety net.
Example: If your out-of-pocket maximum is €3,000:
- After paying €3,000 in deductibles, co-pays, and co-insurance combined
- Insurance covers 100% of remaining costs for the rest of the year
How These Work Together
Here’s a real-world scenario showing how all cost-sharing works:
Your plan: €500 deductible, 80/20 co-insurance, €5,000 out-of-pocket maximum
- January: Doctor visit costs €300 → You pay €300 (toward deductible)
- March: Lab tests cost €250 → You pay €200 (deductible met), then 20% of remaining €50 = €10
- June: Hospital stay costs €10,000 → You pay 20% = €2,000
- Total so far: €300 + €200 + €10 + €2,000 = €2,510
- September: Surgery costs €15,000 → You pay 20% up to your maximum, then insurance covers 100%
Deductibles and Co-Payments by Country
Germany
GKV (Public Insurance):
- No deductible: Coverage starts immediately
- Minimal co-payments: €10/quarter for doctor visits (eliminated in 2013), €5-10 for prescriptions
- Hospital co-pay: €10/day for up to 28 days per year
- One of the most student-friendly systems globally
PKV (Private Insurance):
- Deductibles vary by plan: €0 to €1,200+
- Higher deductible = lower premium
- Some plans offer 0% deductible at higher monthly cost
Learn more about GKV vs. PKV.
United States
The US has the most complex cost-sharing structure:
- Deductibles: $500–$5,000+ per year
- Co-payments: $20–$50 per visit (primary care), $50–$100 (specialist)
- Co-insurance: Typically 20–30% after deductible
- Out-of-pocket maximum: $3,000–$9,000+
- In-network vs. out-of-network: Costs can double or triple for out-of-network care
See our F-1 visa insurance guide for US-specific details.
Australia
OSHC Plans:
- Generally low or no deductibles
- Gap payments possible if provider charges above the schedule fee
- Most key services covered at 100%
Spain
- Public system: No deductibles or co-pays for doctor visits
- Prescription co-pay: 40-50% for working adults, reduced for low income
- Private insurance: Often no deductible (important for visa requirements)
United Kingdom
- NHS: Free at point of service: no deductibles or co-payments
- Prescription charges: ~£9.90 per item in England (free in Scotland, Wales, Northern Ireland)
How Deductibles Affect Your Insurance Choice
Low Deductible Plans
- ✅ Lower out-of-pocket costs when you need care
- ✅ More predictable expenses
- ❌ Higher monthly premiums
- Best for: Students with ongoing health needs, pre-existing conditions, or those who prefer financial predictability
High Deductible Plans
- ✅ Lower monthly premiums
- ✅ Good if you’re generally healthy
- ❌ Significant out-of-pocket costs if you get sick
- ❌ Can discourage seeking care
- Best for: Healthy students on a tight budget who can handle unexpected costs
Tips for International Students
1. Calculate Your Total Cost, Not Just the Premium
A plan with a €50/month premium and €1,000 deductible could cost more than a €80/month plan with no deductible if you need medical care.
Total annual cost = (Premium × 12) + Expected out-of-pocket costs
2. Understand What’s Exempt from the Deductible
Many plans cover preventive care (vaccinations, checkups) without requiring you to meet the deductible first.
3. Check the Out-of-Pocket Maximum
This is your financial safety net. Plans without a maximum can expose you to unlimited costs.
4. Consider Your Health History
If you have pre-existing conditions or anticipate needing regular care, a lower deductible plan usually saves money in the long run.
5. Know Before You Go
Before visiting a doctor, check:
- Is this provider in-network?
- Do I need a referral?
- What will my co-pay be?
- Have I met my deductible?
6. Keep All Receipts
When filing insurance claims, you’ll need detailed receipts and documentation.
Common Mistakes
- Only looking at monthly premiums. A cheap premium with a high deductible can cost more overall.
- Not understanding in-network vs. out-of-network. Especially important in the US.
- Forgetting the deductible resets annually. Plan for this in your budget.
- Assuming all services have the same co-pay. Specialist visits and emergencies often cost more.
- Not checking visa requirements. Some countries (like Spain) require plans with no deductibles.
Take Action: Find the Right Balance
Understanding deductibles and co-payments helps you make smarter insurance decisions. Don’t just go for the cheapest premium, consider your total potential costs.
👉 Compare student health insurance plans and filter by deductible levels to find the right balance between premium and out-of-pocket costs for your situation.