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Most health care plans have cost-sharing that you are responsible for depending on the care you receive. These payments are called out-of-pocket expenses. They fall into the following categories
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Deductible – The amount you must pay for covered health care services before your plan begins to pay. For example, if the deductible is $500, your health plan will not pay anything until you have paid out $500. The deductible may not apply to all services.
Coinsurance – The percentage of costs of a covered health care service for which you are liable for after the deductible has been met. For example, if your health plan pays $100 for an office visit, at a 20percent coinsurance rate, you would pay $20.
Copayment (or Copay) – A fixed amount you pay for a
covered health care service, usually at the time you receive the
service. The amount may vary depending on the type of service you
Usual, Customary and Reasonable Charge (UCR) –
The amount your health plan will pay for a medical service in a
geographic area based on what other providers in that area usually
charge for the same kind of service. You may be responsible for paying
charges that are above the UCR and other out-of-pocket costs.