50 Shades of Insurance Grey - Deductible, Copay, Coinsurance and Out-of-Pocket Maximums

This week Jolene and Sara (who is somehow broadcasting from a submarine) are joined by Todd who helps them understand the difference between deductible, copay, coinsurance and out-of-pocket maximum. A deductible is the amount a member must spend out of pocket prior to the insurance plan covering a portion of the expenses. Coinsurance is the portion of the benefit expense the member is responsible for (e.g.: 20% for a service) after the deductible has been met. A copay is a flat fee for service (e.g. $25 for specialist visits). Short story is that coinsurance is a percentage paid for services and a copy is a flat dollar amount paid for services. Your out-of-pocket maximum is always more than your deductible and is inclusive of all plan spend including copays, deductibles, and coinsurance.