Understanding your deductible
Your deductible is the amount you must pay for covered services before your insurance plan begins to pay for covered services. For example, if your plan has a $1,000 deductible, you’ll pay the first $1,000 for covered services. You can meet the deductible with an all-at-once charge for an expensive service — such as an MRI or surgery — or with charges from several small services — such as doctor visits — where you might pay a small copay. Keep in mind that copays don’t usually count toward your deductible.
Important information about your medical coverage
Coinsurance
Once you’ve met your deductible, you’ll pay coinsurance for covered services. Coinsurance is the percentage of costs you’re responsible for paying, which counts towards your out-of-pocket maximum.
Out-of-pocket Maximum
The out-of-pocket maximum is the maximum amount that you’ll pay out of pocket in a plan year. Once you’ve paid your deductible and paid coinsurance up to the out-of-pocket maximum — all covered services will be 100% paid for by the insurance carrier for the remainder of the plan year. When considering your medical plan options, consideration for the out-of-pocket maximum is essential.
Premiums
Premiums are the monthly costs you pay to use your benefits — think of this like paying for a gym membership — you pay a fee to use the equipment. For insurance, you’re paying a membership fee for discounted services and access to specific providers.
Contributions
MarketStar pays a portion of your monthly premium to limit your monthly cost and provide you with affordable coverage options.
Embedded Deductible
An embedded deductible is where each family member has an individual deductible in addition to the overall family deductible. When a family member meets their individual deductible before the family deductible is reached, the insurance company will begin paying according to the plan’s coverage for that member. If only one family member meets an individual deductible, the rest of the family still has to pay their deductibles until the family deductible is met. No one person will pay more than his or her embedded individual deductible amount.
