What does each term mean?
| Term | What it means |
|---|---|
| Premium | The monthly amount you pay to keep the plan, whether or not you use care. |
| Deductible | What you pay for covered care first. Some services, like preventive care, are covered before you meet it. |
| Copay | A fixed amount, such as $30 for a visit. |
| Coinsurance | Your percentage of a covered cost, such as 20%, after you meet the deductible. |
| Out-of-pocket maximum | The most you pay in a year for covered in-network care. After that the plan pays the rest. |
How do they work together?
Imagine a plan with a $2,000 deductible, 20% coinsurance and a $7,000 out-of-pocket maximum. You have a $10,000 hospital bill. You pay the first $2,000. On the remaining $8,000 you pay 20%, which is $1,600. Your total is $3,600, well below the maximum. The plan pays the other $6,400. Real plans differ, so always check the plan's summary of benefits.
How should I use this to compare plans?
Lower premiums usually come with higher deductibles. If you expect little care, a high deductible plan can cost less over the year. If you expect regular visits, drugs or a procedure, a plan with a higher premium and lower deductible can be cheaper. Also check the network, because out-of-network care can cost much more. An agent can help you estimate costs with your own doctors and prescriptions.
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