My Coverage Explained

Decoding Doctor’s Office Deductibles

 Pop quizzes and making you pull out your calculators seems like cruel and unusual punishment, doesn’t it? Figuring out your insurance deductibles sounds like it could be hard, but let’s simplify and break it down. We can do the math together— no calculator needed! We’ll even give you a cheat sheet to help you remember these key insurance terms:

  • Deductible
    A deductible is the amount you have to pay before the health plan starts paying for your covered services. For instance, if your deductible is $1,000, your plan won't cover some services until you've paid $1,000. 
  • Coinsurance
    Coinsurance is the percentage of the cost that you have to pay for a covered service, which applies after you’ve met your deductible.
  • Copayments
    A copayment (also known as a copay) is the fixed dollar amount you might have to pay at the time you receive care. It’s usually a small amount, such as $20 for a doctor's exam and you won't always have to pay copayments. How much you pay depends on your health plan and what type of doctor you visit.
  • Out-of-pocket Maximum
    The out-of-pocket maximum is the amount you have to pay for eligible costs under your health care plan, during a certain period of time. This amount may or may not include deductible amounts, copay amounts, or out-of-network amounts; you can contact us directly to verify what is included in your plan's Out-of-pocket Maximum.

When choosing and using your health insurance, you need to know how your health plan works and what your out-of-pocket costs may be. Let’s look at an example:
Deductibles Insurance


So what about my premium? What does it do?

The amount you pay for your premium are what keep your plan active which allows us to process your claims for services. Your premium payment is separate from the deductible and out of pocket amounts that are applied to your claim.

In some cases, the higher your deductible, the lower your monthly premium payment. The lower the deductible, the higher premium.

For more info on understanding health insurance, browse our website, call us at the number on the back of your Membership ID card, or visit our mobile health insurance center  in your area.

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