The amount you owe for covered health care services before your health insurance or plan begins to pay. For example, if your deductible is $1,000, your coverage will kick in once you’ve paid $1,000 toward covered health care services subject to that deductible. Please know, many plans have separate deductibles for different things, such as in-network versus out-of-network care. Know exactly how your deductibles work as it greatly influences how much you will pay out of pocket.
Copays exist in certain plans. A copay is a fixed amount you will pay for certain covered health care services (ie. a physician office visit) received from an in-network provider. The amount can vary by the type of covered health care service. Copays apply before deductibles are met in some CGHC plans, but this is not always the case so be sure you understand how copays work in the plans you choose.
Your share of the costs of a covered health care service, calculated as a percent of the discounted cost your health plan has negotiated for the service. You pay coinsurance plus any deductibles you owe before you reach your out-of-pocket maximum.
The most you could pay for care in a year, adding up your deductible, copayments, and coinsurance payments. Plans may have different out-of-pocket maximums. Once you have paid that amount, your plan will pay the full cost of all of your covered health care services for the rest of the year. Once again, health plans typically have different out-of-pocket maximums (also referred to as MOOPs) for in-network versus out of network care.
IN NETWORK vs. OUT OF NETWORK CARE
The providers your health insurance company has contracted with to provide health care services, usually at a discounted rate. Typically, your costs are lower with an in-network provider.
An out-of-network provider is one not contracted with your health insurance plan. Out-of-network care is not covered for individual and family plans except in very limited circumstances. Please review our FAQs page for details.