Understanding Your Out-of-Pocket Costs

Depending on your insurance benefits, you may be responsible for a portion of the cost of your care.

Deductible: The amount you may be required to pay toward covered healthcare services before your insurance begins paying according to your plan benefits.

Copay: A fixed amount you may be required to pay for a healthcare service.

Coinsurance: A percentage of the cost of a covered service that you may be responsible for after your insurance processes the claim. If your plan lists a percentage, such as 20% coinsurance, that percentage alone may not tell you the actual dollar amount you will owe.

High-Deductible Health Plans

If you have a high-deductible health plan, you may be responsible for a substantial portion of your healthcare costs until your deductible has been met.

For example, if your plan has a $3,000 deductible and you have met $500, some or all of the applicable charges for your services may be applied toward the remaining deductible. Coinsurance may also apply after your deductible has been met, depending on your plan.

Covered Does Not Mean Free: A service can be covered by your insurance, performed by an in-network provider, and properly authorized while still resulting in significant patient responsibility because of your deductible, copay, or coinsurance.