Answer
What do deductible, copay, coinsurance, and out-of-pocket maximum mean?
The short answer
Your premium is what you pay to have the plan. For care, you often pay the deductible first. Then you may pay a copay (a set amount) or coinsurance (a percentage). The out-of-pocket maximum is the most you pay for covered, in-network care in a year.
Key takeaways
- Premiums keep your coverage active. They usually do not count toward your deductible.
- Some services, such as many preventive visits, may be covered before you meet your deductible.
- After you reach the out-of-pocket maximum, the plan pays 100% of covered in-network care for the rest of the plan year.
Words in this lesson
- Premium
- The amount you pay, often monthly or per paycheck, to keep your health coverage.
- Deductible
- The amount you pay for covered care each plan year before your plan starts to share most costs.
- Copay (copayment)
- A set dollar amount you pay for a covered service, such as $30 for a doctor visit.
- Coinsurance
- Your share of a covered cost as a percentage, such as 20%, usually after you meet your deductible.
- Out-of-pocket maximum
- The most you pay in a plan year for covered in-network care. After that, the plan pays 100% of covered in-network costs. Premiums do not count.
Related
This is general education. For decisions about your own plan, taxes, or legal rights, check your plan documents or a qualified professional.