Deductible – The portion of any claim that is not covered by the insurance provider. It is the amount of expenses that must be paid out of pocket before the insurer will cover any expenses. It is normally quoted as a fixed amount and must be paid in full by the insured before the policy benefits can be applied. This amount starts over at the beginning of the plan year.
Co-payment – A payment defined in the insurance policy and paid by the insured person each time a medical service is provided. This amount is set by the insurance policy and must be paid before any policy benefit is payable by the insurance company.
Co-insurance – The percentage paid by the insured after the deductible amount has been met up to the policy’s stop loss. It is expressed as a pair of percentages with the insurer’s portion stated first. 70/30, 80/20, and 90/10 are all common co-insurance percentages with the insurance company covering, for example 70% and the patient being responsible for the remaining 30%. Once the patient has met their out of pocket expense maximum the insurance company will assume responsibility for 100% of the costs.