The premium is the amount you (or your employer) pay for your health insurance plan whether you use medical services or not. In most cases, it’s paid monthly, but can be paid every 3 months or yearly.
A deductible is the amount you must pay before the health plan starts paying for your covered services. For example, if your deductible is $1,000, your plan won’t pay for some services until you’ve paid $1,000. In most cases, the higher your deductible, the lower your premium. The lower the deductible, the higher premium.
Coinsurance is the percentage of the cost that you must pay for a covered service. It applies after you meet your deductible.
For example, let’s say it costs $100 to see your doctor. If your coinsurance is 20%, you must pay $20 and the insurance plan pays $80. If you haven’t met your deductible, you must pay the entire amount.
A copayment is a fixed dollar amount you may have to pay at the time you get care. In most cases, it’s a small amount, such as $20 for a doctor’s exam. You won’t always have to pay copayments. The amount you pay depends on your health plan and which doctor you see.
Also called OOPM, this is the most you have to pay out of your own pocket for expenses under your insurance plan during the year. Deductibles, coinsurance, copays and other expenses for in-network essential health benefits (EHBs) apply to the OOPM.
If you have questions regarding your insurance coverage, our office does free verification of beneifts to let you know what services may or may not be covered.