Key Insurance Terms

  • The deductible is the amount that the customer must pay out of pocket every year before the insurer begins to meet the costs.
  • Copays are set fees that subscribers must pay for specific services such as doctor visits and prescription drugs even after the deductible is met.
  • Coinsurance is the percentage of healthcare costs that the insured must pay after they have met the deductible (but only until they reach the out-of-pocket maximum for the year).
  • Out-of-pocket maximum is the most you must pay per year for covered healthcare services. When you have spent this amount in your plan year on deductibles, copayments, and coinsurance for in-network care and services, your health insurer will pay for 100% of your healthcare services.