Five health-insurance terms that control your cost

The short answer: You pay the premium to keep coverage. When you use care, you may pay toward the deductible, then a copay or coinsurance. The out-of-pocket maximum limits what you pay for covered care under the plan's rules during the plan year.

1. Premium

The amount charged to keep the plan active, usually described as a monthly amount. If coverage comes through work, the employer may pay part and your share may come out of each paycheck. Premiums generally do not count toward the deductible.

2. Deductible

The amount you pay for covered services before the plan starts paying its share for many types of care. Some services may be covered before the deductible, and a plan can have separate deductibles. Check the plan documents.

3. Copayment

A fixed amount for a covered service—$30 for an office visit, for example. Whether a copay applies before or after the deductible depends on the plan.

4. Coinsurance

A percentage of the plan's allowed amount for a covered service. If the allowed amount is $100 and your coinsurance is 20%, your share is $20 after any applicable deductible has been met.

5. Out-of-pocket maximum

The most you pay during the plan year for covered services under the plan's rules. Premiums, care the plan does not cover, and some out-of-network charges may not count. After you reach the limit, the plan generally pays 100% of covered in-network benefits for the rest of the plan year.

Official sources

• HealthCare.gov: Deductible
• HealthCare.gov: Coinsurance
• HealthCare.gov: Out-of-pocket costs
• HealthCare.gov: Out-of-pocket maximum

Educational information only, not medical, benefits, or financial advice. Your Summary of Benefits and Coverage and plan documents control.