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Glossary of Health Insurance terms

Deductible
The deductible is the amount you must pay for medical care out of your own pocket before your health insurance begins to pay benefits.

Coinsurance
This refers to your share—usually expressed as a percentage—of medical bills that you must pay after your insurance provides coverage. For example, if your coinsurance is 20%, you will be responsible for 20% of your medical costs and the insurer pays the other 80%.

Copayment
The deductible is the amount you must pay for medical care out of your own pocket before your insurance begins to pay benefits.

Out-of-pocket maximum
Most health insurance plans limit the amount of money you will have to pay out of your own pocket for medical care. After your costs reach this out-of-pocket maximum, your insurance will pay for 100% of covered expenses. It is very important to read how this is defined in your insurance policy. Deductibles and copayments may not count toward this maximum. Your insurance company may continue to charge copaymens for office visits or prescription drugs even after you’ve reached the out-of-pocket maximum.

Most deductibles and out-of-pocket maximums are calculated on a calendar-year basis. Policy year and per-cause deductibles and out-of-pocket maximums are rare but still exist.

 
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