Glossary Of Health Coverage And Medical Terms Page 4
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4How You and Your Insurer Share Costs - Example
Jane’s Plan Deductible: $1,500
Co-insurance: 20%
Out-of-Pocket Limit: $5,000
st
st
December 31
January 1
End of Coverage Period
Beginning of Coverage
Period
more
more
costs
costs
Jane pays
Her
plan
pays
Jane pays
Her plan pays
Jane pays
Her plan pays
100%
0%
20%
80%
0%
100%
Jane hasn’t reached her
Jane reaches her $1,500
Jane reaches her $5,000
$1,500
deductible
yet
deductible,
co-insurance
begins
out-of-pocket limit
Her plan doesn’t pay any of the costs.
Jane has seen a doctor several times and
Jane has seen the doctor often and paid
Office visit costs: $125
paid $1,500 in total. Her plan pays some
$5,000 in total. Her plan pays the full
Jane pays: $125
of the costs for her next visit.
cost of her covered health care services
Her plan pays: $0
Office visit costs: $75
for the rest of the year.
Jane pays: 20% of $75 = $15
Office visit costs: $200
Her plan pays: 80% of $75 = $60
Jane pays: $0
Her plan pays: $200
Glossary of Health Coverage and Medical Terms
Page 4 of 4
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