How You and Your Insurer Share Costs - Example Jane’s Plan Deductible: $1,500 Co-insurance: 20% Out-of-Pocket Limit: $5,000
December 31 st End of Coverage Period
January 1 st Beginning of Coverage Period
more costs
more costs
Jane pays 100%
Her plan pays 0%
Jane pays 20%
Her plan pays 80%
Jane pays 0%
Her plan pays 100%
Jane hasn’t reached her $1,500 deductible yet Her plan doesn’t pay any of the costs. Office visit costs: $125 Jane pays: $125 Her plan pays: $0
Jane reaches her $1,500 deductible, co-insurance begins Jane has seen a doctor several times and paid $1,500 in total. Her plan pays some of the costs for her next visit. Office visit costs: $75 Jane pays: 20% of $75 = $15 Her plan pays: 80% of $75 = $60
Jane reaches her $5,000 out-of-pocket limit Jane has seen the doctor often and paid $5,000 in total. Her plan pays the full cost of her covered health care services for the rest of the year. Office visit costs: $200 Jane pays: $0 Her plan pays: $200
Glossary of Health Coverage and Medical Terms
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