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Deductible
The amount you pay out of pocket each year before your plan starts covering costs.
Example: You break your arm. ER costs $2,000. You pay $1,500 — insurance covers the rest.
Premium
The fixed monthly amount you pay to keep your insurance active, whether you use it or not.
Example: You pay $280/month. Even with zero visits, you’ve paid $3,360 this year.
Out-of-pocket max
The most you’ll ever pay in covered costs in a single plan year. After this, insurance pays 100%.
Example: Your OOP max is $7,000. Once you hit it, everything else covered is free.
Copay
A fixed dollar amount you pay for a specific service, like a doctor visit or prescription.
Example: Your plan has a $30 copay for PCP visits. Every time you go, you pay $30.
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