Deductible.
A deductible is the amount you pay for covered healthcare services before your insurance plan starts to pick up the costs. Your deductible varies depending on your plan. A higher deductible plan may have a lower monthly premium, but may require you to spend more out of your own pocket before any of your insurance coverage kicks in. For example, if you have a $2,000 deductible, you’d need to spend that on your health services before your insurance picks up any other costs.
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Premium.
The amount you pay monthly to keep your insurance plan active. This varies depending on how comprehensive your coverage is. For example, a plan with a higher monthly premium usually covers more healthcare services and includes additional benefits than a lower-premium plan. Lower-premium plans very often cover less but may be preferred by someone who does not use a lot of healthcare services.
Copay.
A copay is a fixed dollar amount that you’ll pay out of your own pocket for services under your insurance plan. A copay usually remains the same regardless of the provider’s fees or the total bill. For example, you might pay $20 for a routine doctor visit, $40 for an urgent care visit, or $15 for a prescription medication.
Coinsurance.
Coinsurance is the percentage of healthcare costs that you pay after you’ve met your annual deductible. The coinsurance percentage shows the amount of costs you’re responsible for when paying medical expenses, with your insurance company covering the rest.
Coinsurance typically appears as a ratio, such as 80/20, which means your insurance company covers 80% of the cost while you’re responsible for paying 20%. For example, if you need an MRI that costs $2,000, you’ll pay 20% ($400) and your insurance covers 80% ($1,600.)
In-network vs. out-of-network.
Simply put, an in-network or participating provider is a doctor or healthcare service provider who accepts your insurance plan. An out-of-network provider is a doctor or health care service provider who does not accept your insurance plan. If you use an out-of-network provider, you may have to pay more for the care received, because that provider doesn’t have an agreed-upon payment rate with your health insurance plan.