Cost-sharing
Deductible
The amount you pay out-of-pocket for covered services before the insurer starts paying. Most plans waive the deductible for preventive care. Deductibles reset annually. Plans with higher deductibles typically have lower premiums; HDHPs pair high deductibles with HSA savings.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.
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.
Allowed amount
Maximum the plan considers reasonable for a service.
Balance billing
Out-of-network provider bills you the gap.
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