They pay nothing until the deductible. Even better is that it is a family deductible so we have to reach $6,000 before they pay anything. That $6,000 can be from just one person, or the total medical bills for the family. My copays don’t kick in until we reach the deductible. So if I go to the dr for a sick visit then I pay the whole dr bill myself (well visits like yearly checkups and the kids vaccinations are covered 100% by insurance). We then have an Out of Pocket Max of like $7,000. The copays that we pay after reaching the deductible count toward that $7,000. The copays apply to ER visits, dr visits, and medication, But not to tests, or hospital stays, ect. So we pay the first $6,000 of medical bills, then we pay and additional $1,000 in copays to reach the $7,000 out of pocket max. So that is not a strange or crazy insurance. On the “plus” side – with a deductible like that, you should be eligible to open an HSA (Health Savings Account). The money you put into an HSA is pre-tax and then you can use the HSA funds for medical bills including dental and vision.