Decoding Doctor’s Office Deductibles

 Get out your calculators, it’s time for a quiz! That would be cruel and unusual punishment, right?

Doesn’t figuring out your insurance deductibles seem difficult enough? Let’s simplify and break it down. We can do the math together. No calculator needed and we’ll even give you a cheat sheet to help you remember these key insurance terms:

  • Deductible
    A deductible is the amount you must pay before the health plan starts paying for your covered services. For example, if your deductible is $1,000, your plan won't pay for some services until you've paid $1,000. 
  • Coinsurance
    Coinsurance is the percentage of the cost that you must pay for a covered service. It applies after you meet your deductible.
  • Copayments
    A copayment (or copay) is a fixed dollar amount you may have to pay at the time you get care. In most cases, it's a small amount, such as $20 for a doctor's exam. You won't always have to pay copayments. The amount you pay depends on your health plan and which type of doctor you see.
  • 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 as example of how deductibles, coinsurance and maximum limits work.
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 information on understanding how health insurance works, explore 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.

Keep “connecting” with us for more useful info about your health insurance!

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