Paying for Health Care with Insurance

The amount paid per month for an insurance policy.

The negotiated amount that a health care plan has agreed that providers will be paid for a covered health care service. May also be called “eligible expense,” “payment allowance,” or “negotiated rate.”

A percentage amount of the allowed cost of your medical care that you are required to pay. For example, with an 80/20 plan, if the charge for medical services was $100, and you had met your deductible, of the $100 charge, you would pay 20%, or $20, and your insurance would pay the remaining 80%, or $80.

A fixed amount you may be required to pay for office visits, pharmacy, emergency room, outpatient care, labs, surgeries, etc. prior to or after meeting your deductible.

The annual amount that your insurance company requires you to pay for medical services before they will start to pay for the care that you receive. Except for certain preventive services, and those for which there is a co-payment, commercial carriers typically will not pay for any health care services until you have met your deductible. Once the deductible has been met, you most likely will still be required to pay something for the health care services which you receive until you have met your out-of-pocket maximum.

The most that you can be required to pay for covered medical costs within a given plan benefit year, not including your monthly premium. This typically consists of the amount that you pay for deductibles, co-pays, and co-insurance.

A plan with a higher deductible (as defined by the IRS) than a traditional insurance plan. The monthly premium is usually lower, but you pay more health care costs yourself before the insurance company starts to pay its share. A high deductible plan can be combined with a health savings account (HSA), allowing you to pay for certain medical expenses with tax-free money.