A handful of terms shape how most health plans work. Understanding them makes it easier to compare plans beyond the monthly premium.
Premium and deductible
The premium is the recurring amount paid to keep coverage active. The deductible is an amount you may pay for covered services before certain plan benefits begin, subject to the plan’s rules.
Copay and coinsurance
A copay is a fixed amount for a covered service. Coinsurance is a percentage of an allowed cost you may owe. Plans can use one, both, or neither for different services.
Maximum out-of-pocket
For applicable covered, in-network services, this is a plan-year limit on certain cost sharing. Premiums, non-covered care, and out-of-network expenses may not count.
Provider network
A network is the group of providers and facilities contracted with the plan. How out-of-network care is handled varies, so verify before receiving non-emergency care.
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