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Deductible is the amount you need to pay each year for covered services before your plan starts paying towards your benefits.
Co-pays are fixed dollar amounts (for example, $15) you pay for covered health care, usually when you receive the service.
Coinsurance is your share of the costs of a covered service, calculated as a percent of the allowed amount for the service. For example, if the plan’s allowed amount for an overnight hospital stay is $1,000, your coinsurance payment of 20% would be $200. This may change if you haven’t met your deductible.
Allowed Amount is the amount the insurance plan pays for covered services based on a fee schedule through an in-network provider agreement. If an out-of-network provider charges more than the allowed amount, you may have to pay the difference. For example, if you see an out-of-network provider that charges $152.00 for a massage and the allowed amount is $59.23 you may have to pay the $92.77 difference.
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