This is a fixed amount that you pay to your insurance plan. Payments are generally made on a month to month basis. You pay this cost whether or not you receive medical care that month.

This is the amount of money you pay for medical care before the insurance company starts to pay for care. You pay a pre-determined, fixed amount of money each time you receive medical care. Once you have paid that amount, or “meet your deductible”, your insurance company begins to cover some costs of your medical care. You can choose whether you have a high deductible or low deductible plan.

This is the fixed amount you pay for medical care services per visit after you have met your deductible. The health plan will pay the rest of the cost for the visit. For example, you may pay $30 for a physician visit at the time of the visit that would normally cost $150. The insurance company would be responsible for paying the remaining $120.

The type of coverage needed to meet the health insurance requirement under the Affordable Care Act. This includes Marketplace coverage, job-based coverage, Medicare, Medicaid, TRICARE, the Children’s Health Insurance Plan (CHIP), and certain other insurance plans.

• This is the highest amount you will have to pay out of pocket (deductibles, copayment, or co-insurance) for the year if you get sick. This amount does not include premium costs, balance-billing (the amount you have to pay after exceeding the Health Plan’s reimbursement for covered service), or health care services your insurance plan does not cover.
• Some insurance plans do not count out of pocket costs toward the out-of pocket maximum limit.
• In Medicaid and the Children’s Health Insurance Plan (CHIP) the limit does include the premium.