From Deductibles to Co-pays: Health Insurance Terminology Explained

May 24, 2021 / Molina Healthcare

From Deductibles to Co-pays: Health Insurance Terminology Explained

Health insurance helps you stay well and cover your costs when you’re sick or injured. But what do the particular words used by insurance companies and providers mean?

To help you get a deeper understanding, we’ve provided simple explanations of the most commonly used terms, below.

  • Premium: Like auto and home insurance, health insurance requires you to provide a payment each month to make sure your coverage isn’t interrupted. This is called a premium. The size of your premium varies based on your choice of plan and usually resets every year.
  • Cost Sharing: This general term refers to medical or pharmacy expenses you and your insurer pay together. Some health plans require cost sharing and others don’t. It just depends on the plan you have. Types of cost sharing include—
    • Deductible: This is the dollar amount you chip in every year before your insurer begins to pay for covered services. Once you meet your deductible, your plan covers your costs.
    • Coinsurance: Some insurance plans require you to pay a percentage of certain medical costs while they pay the rest. This is called coinsurance.
    • Co-payments: These are fixed fees you give participating providers when you get treatment at their office, urgent or emergency care, or when you get other supplies or services, like prescription drugs or screenings.
  • Out-of-Pocket Maximum: This is a dollar amount set by your insurer as the most you will pay in a year. When the deductible, coinsurance and co-payments you have paid add up to the annual Out-of-Pocket Maximum, your plan will pay for everything else (except your premium).

To make sure everyone can get the help they need to stay healthy, organizations like Molina Healthcare offer a wide range of plans at different price points—all with access to quality care.

We hope these explanations are helpful. Still got questions? Lean on Molina. Feel free to check out our website at for more information.

Category: Health Insurance