Health Insurance Fundamentals

The Five Terms That Unlock Everything

Premium, deductible, copay, coinsurance, out-of-pocket max

Nearly everything in health insurance is a combination of five numbers. The premium is your monthly bill. The deductible is what you pay before the plan starts sharing costs. Copays are flat fees for visits. Coinsurance is the percentage you share after the deductible. The out-of-pocket maximum is the most you can pay in a year, and after you hit it the plan pays 100 percent.

The tradeoff behind every plan

Lower premiums almost always mean higher deductibles, and vice versa. Neither is wrong. A healthy person who rarely sees a doctor may save with a high-deductible plan; someone managing a condition usually comes out ahead paying more monthly for lower visit costs.

Networks decide your real cost

The same plan can be affordable in network and painful out of network. Before choosing any plan, the single highest-value step is confirming your doctors and hospital are in its network. We do this check on every quote we prepare.