What do all of these terms mean? Deductible, coinsurance, copay, Maximum out of pocket?
A copay is a flat amount that you pay for a service described in your insurance policy; most times this term is applied to seeing your Primary Care Physician or a Specialist. The insurance company negotiates these rates on your behalf with those doctors that accept the policy you have purchased.
When you see that a deductible applies on your policy for a medical service you need according to what your doctor or medical facility charges up to a set dollar amount that is declared in your policy. This can range anywhere from $0 to $6,350 per individual on your policy. Once you have met the deductible amount for the year, coinsurance may apply.
Coinsurance is where the costs above the deductible are split between you and the insurance company by a declared percentage in your policy. This can range from 0 to 100 percent.
A maximum out of pocket, often abbreviated as MOOP, is set in your policy where after you spend a certain amount between copays, deductibles, and coinsurance for all individuals covered under your policy, the insurance company covers the cost 100 percent. The maximum out of pocket allowed on most all health insurance plans is $12,700 for a family or $6,350 for an individual.