Cost-sharing
Coinsurance
The percentage of covered medical costs you pay after meeting your deductible. With 80/20 coinsurance, the insurer pays 80% and you pay 20% until you reach your out-of-pocket maximum. In-network coinsurance is lower than out-of-network coinsurance.Last reviewed: · TMRW Benefits is a benefits brokerage, not a tax or legal advisor. Consult a CPA or attorney for situation-specific guidance.
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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.
Out-of-pocket maximum (OOP max)
Annual cap on your covered in-network costs.
Allowed amount
Maximum the plan considers reasonable for a service.
Balance billing
Out-of-network provider bills you the gap.
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