A deductible is the amount you pay for health services before your insurance begins to share costs. For instance, if your deductible is $1,500, you’ll pay for eligible services up to that amount before your insurance kicks in to cover part of the costs.  

• A copay is a fixed amount you pay for certain in-network services, like a doctor’s visit, a prescription, or an emergency room trip. The amount depends on the type of service. For example, if your primary care physician copay is $20, you will pay this amount every time you visit the doctor.    
• Coinsurance, on the other hand, is a percentage of the cost you’ll pay after receiving eligible healthcare services. Unlike a copay, it varies with the total cost of the service. For example, if you have an 80/20 plan, that means your plan covers 80% and you pay 20%, up until you reach your maximum out-of-pocket limit. 

Learn more about copays and coinsurance in this short video.

A Primary Care Physician, or PCP, is your main doctor for routine care, preventive services and early treatment. They’re your go-to for health concerns, can coordinate your care with other doctors and having one means you’ll know who to call when you need help managing your care. Some plans may require you to designate a PCP before benefits are paid.  

Your out-of-pocket maximum is the most you’ll pay in a year for eligible health services. Once you hit this limit, your insurance pays 100% of covered services for the rest of the year. For example, if your out-of-pocket maximum is $5,000, you won’t pay anything beyond that for services like doctor visits or hospital stays.