Cost-sharing
Premium
The monthly amount you pay to keep a health plan active, regardless of whether you use any care. Premiums are paid to the carrier (or to the employer for group plans). Premiums are separate from deductibles, copays, and coinsurance — they keep the policy in force.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
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.
Allowed amount
Maximum the plan considers reasonable for a service.
Balance billing
Out-of-network provider bills you the gap.
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