Frequently Asked Questions

  • A premium is the amount that must be paid for your health insurance plan. It’s usually a monthly, quarterly or yearly bill.

    A deductible is the amount on top of your premium that you are required to pay before your health insurance carrier begins to pay. For example, if your deductible is $1,000, your plan won’t pay anything until you’ve met your $1,000 deductible for covered health care services. The deductible may not apply to all services.

    Coinsurance is the percent that the insurer pays after the policy’s deductible is exceeded. So it’s your share of the costs of a covered benefit. For example, if the health insurance or plan’s allowed amount for an office visit is $100 and you’ve met your deductible, 20% coinsurance payment would be $20. The insurance carrier pays the rest of the allowed amount.

    A copayment is a fixed amount you pay for a covered health care service, like a doctor’s visit, usually when you get the service. For example, if you have a $15 copay, you pay that to the doctor, and your health insurance carrier is billed for the remainder of the bill.

    Out-of-pocket expenses are costs for health care that aren't reimbursed by insurance. Out-of-pocket costs include all of the above expenses (deductibles, coinsurance, and copayments). All health services not covered by a plan are considered out-of-pocket costs.