The four numbers that decide what you pay
These four terms do most of the heavy lifting on any plan.
- Premium — what you pay every month to have the plan, whether you use it or not.
- Deductible — what you pay yourself before the plan starts sharing most costs.
- Copay / coinsurance — your share of a visit or service after the deductible (a flat copay like $30, or a percentage like 20%).
- Out-of-pocket maximum — the most you'll pay in a year. After you hit it, the plan covers 100% of covered care.
How they work together
Think of it as a sequence. You pay your premium every month no matter what. When you get care, you first pay toward your deductible. After that, you and the plan share costs through copays or coinsurance. Once your total spending hits the out-of-pocket maximum, the plan picks up everything else for the rest of the year.
That out-of-pocket maximum is the real safety net — it caps your worst-case year.
Networks matter just as much
Every plan has a network of doctors and hospitals it has agreements with. Staying in-network keeps your costs down; going out-of-network can cost a lot more.
- HMO — usually lowest cost, but you stick to the network and often need a referral for specialists.
- PPO — more flexibility to see who you want, usually a higher premium.
- EPO — a middle ground: network-only, but often no referrals needed.
- POS — a mix of HMO and PPO rules.
Before you enroll, check two things
Always confirm your doctors are in the plan's network and your prescriptions are on its drug list before you sign up. A plan with a low premium isn't a deal if your doctor isn't covered. We check both for you, for free, before you enroll.