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Understanding healthcare payments

You pay for your medical care and insurance in different ways.  Understanding healthcare payments and what the terms mean will help you feel more comfortable when making decisions for you and your family.

Premium is the flat fee you pay each month for health insurance. If you’re on an employer plan, it comes out of your paycheck.

Copayment (or copay) is the fixed amount you pay for a service. Often, it varies based on the type of visit. Depending on your health plan, you may not have a copay.

A deductible is the total amount you pay for care and medications before your health insurance begins to help pay. Your plan allows certain medical charges to go toward your deductible. There are different deductible amounts for in-network and out-of-network services. Premiums and copays do not count toward your deductible.

Coinsurance is the percentage of the cost that you are responsible for paying. Once you meet your deductible, your insurance begins to help pay. How much it pays depends on your plan and if you’re getting care in or out of network.

Out-of-pocket max is the most you pay for covered health services in a calendar year. Once you reach it, your insurance covers 100% of any further eligible healthcare expenses. The out-of-pocket limit does not include premium payments or charges for services that are not covered.

Are you curious about more of the basics of health insurance? Learn more at You can also go to the Arkansas Blue Cross and Blue Shield website to learn more about your health plan and benefits.

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