What does your cost share mean?
We get it, health insurance can be confusing. Sometimes it feels like everywhere you turn, another term is thrown your way, and you're expected to know exactly what it means. Where are the "Health Insurance for Beginners" or "Medical Insurance 101" classes when you need them?
We want to break down these confusing terms and make them easier for you to understand.
Cost-related terms and their meanings
After you've paid your deductible, coinsurance is your portion (a percentage) of the cost for medical services listed as benefits in your insurance plan or prescriptions on the approved drug list.
A copay is the portion you pay at the time you receive a health care service. You may also have a copay when you get a prescription filled at the pharmacy. Generally, you will pay a flat-dollar copay.
The part of health care costs that you have to pay based on your insurance plan. Examples of cost share include: deductibles, coinsurance, or copays.
The amount you pay each year before your health plan starts to pay for certain services. Once you've met your deductible in a given year, we begin to pay a share of the cost for your health care services. Always check your plan documents for a list of costs that count toward your deductible.
This is your annual maximum cost. It's the most you'll pay for health care services including copays and prescription drugs in one year.
The monthly amount you pay for your health insurance. Whether you pay for your health insurance on your own, or you and your employer each pay a share of the cost, your premium is the monthly payment to keep your health insurance active.
Whether you've met your deductible or not, we pay for preventive health care services in full when you receive them from an in-network provider. Check our preventive health care guidelines for a complete list of services provided at no cost to you.
Getting to know what insurance terms mean and how the cost of your care is shared between you and your health plan is the key to fully understanding your benefits. Make sure to check out upcoming Health Journal issues for more on understanding your benefits.
Check out our glossary for more health insurance terms.
In this issue
Your partner in health
New at Priority Health
- Pre-approval: What it means for you and your care
- Helping you at every twist and turn of life - including retirement