Understanding Your Coverage

It’s easy to find yourself confused by the medical insurance jargon you may encounter when trying to choose a health insurance plan. Familiarize yourself with the basics to help you find the one that best meets your needs.

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Health Insurance Co-Pays

A co-pay or co-payment is the amount you have to pay that is not covered by your health insurance plan. If your plan includes a co-pay, you usually have to pay that amount for services such as doctor's visits, medical tests and treatments, and prescription drugs. The amount of your co-pay can vary by plan. Your co-pay amount is generally listed on your health insurance card.

Out-of-Pocket Expenses

Out-of-pocket costs are those health-care expenses you pay that are not reimbursed by your health insurance company. Some common out-of-pocket costs include your deductible, co-pay, and co-insurance.  Your health plan will "cap" your out-of-pocket expenses, which means that once you reach the maximum out-of-pocket costs for your plan, your health plan takes over and provides coverage.

Generally speaking, your out-of-pocket expenses are applied toward your deductible. After you meet your deductible, you may still pay either a co-pay and/or co-insurance amounts when you receive medical services or prescription drugs. Review your plan documents for specific details on your plan’s out-of-pocket expenses and deductibles.


Click here for more information on managing your deductible.