Premium
This is the amount you pay each month for your health insurance plan
Deductible
The amount you pay out of pocket each year before your insurance starts covering costs. Some services e.g., doctor visits do not require that you meet your deductible first, depending on the plan benefits.
Copayment (Copay)
A fixed amount you pay for a specific service, like a doctor’s visit or prescription—usually at the time of the visit.
Example: You might pay $20 for a doctor’s visit, and your insurance plan pays the rest.
Coinsurance
The percentage of costs you pay after you’ve met your deductible.
Example: If your plan pays 80%, you’ll pay the remaining 20%
Out-of-Pocket Maximum
This is the most you will pay in a year for covered services. Once you reach this limit, if applicable, your insurance pays 100% of the costs for covered services.
Network
A group of doctors, hospitals, and other health care providers that work with your insurance plan. Staying “in-network” typically means lower out of pocket costs. HMO plans provide in network coverage only and PPO plans allow you to access care in network and out of network. Other plan types may also available e.g., EPOs and POS. Reach out to us to explain those options!
