Cost-sharing
Allowed amount
The maximum amount a plan considers reasonable for a covered service. The carrier pays its share of the allowed amount, you pay the rest (up to OOP max). For out-of-network care, providers can sometimes bill you for the difference between charges and the allowed amount — known as balance billing.Last reviewed: · TMRW Benefits is a benefits brokerage, not a tax or legal advisor. Consult a CPA or attorney for situation-specific guidance.
More in Cost-sharing
Premium
Monthly payment to keep coverage active.
Deductible
Out-of-pocket amount you pay before insurance starts paying.
Copay
Flat fee per service. Often not subject to the deductible.
Coinsurance
Percentage of cost you pay after deductible.
Out-of-pocket maximum (OOP max)
Annual cap on your covered in-network costs.
Balance billing
Out-of-network provider bills you the gap.
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