Open enrollment for 2020 health care plans is just around the corner (see dates in column at right). Let’s clarify the most frequently misunderstood health insurance terms:

1. Deductible: This is the amount you pay for eligible health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of eligible services yourself.
2. Co-insurance: This is the percentage of costs of a covered health care service you pay (20%, for example) after you’ve paid your deductible. Let’s say your health insurance plan’s allowed amount for an office visit is $100 and your coinsurance is 20%. If you’ve paid your deductible: You pay 20% of $100, or $20. The insurance company pays 80%, or $80. If you haven’t met your deductible: You pay the full allowed amount, $100.
3. Co-pay: This is the fixed amount ($20, for example) you pay for a covered health care service after your deductible is met. For example,
   let’s say your health insurance prescription co-pay is $10/$60/$120, you will pay $10 for a generic drug; $60 for a preferred brand-name drug; or
   $120 for a non-preferred brand-name drug each time your prescription is filled. If you have a high-deductible health plan, you must meet your deductible before most prescription benefits take effect.
4. Out-of-pocket maximum: This is the most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance, your health plan pays 100%
   of the costs of covered benefits. The out-of-pocket limit doesn’t include your monthly premiums. It also doesn’t include anything you spend for services your plan doesn’t cover.

Call MDA Insurance at 877-906-9924 for additional assistance.