Several factors determine health insurance costs, so understanding the basic costs associated with a plan, including monthly plan premium, deductible, out-of-pocket maximum and office visit copays will help you find a plan that meets your needs and budget.
Coinsurance: Your share of the costs of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service. You pay coinsurance plus any deductibles you owe.
Copayment: A fixed amount (for example, $15) you pay to the healthcare provider for a covered health care service, usually paid at the time of service.
Deductible: This is how much you will pay out-of-pocket per calendar year before your coverage will apply.
Maximum Allowable Charge: The amount billed for covered services for which benefits are available under the contract.
Monthly Plan Premium: This is how much you will pay for plan coverage each month. To know your annual premium costs, multiply the monthly premium by 12.
Out-of-Pocket Maximum: This amount is the MOST that you will pay out-of-pocket for in-network medical expenses during the calendar year for your care. This is not a deductible. This does not include payments for monthly premiums and prescription drug costs.