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What are the differences between a copay, a deductible, and an out-of-pocket maximum?

Copays are a fixed amount you pay for a covered service at the time you receive that service. The amount may vary by the service provided. An example would be an office visit copay at your primary care physician’s office.

A deductible is the amount you pay for expenses before the insurance plan will cover the remaining costs, outside of copays. Some services may be covered at a certain percentage “after deductible,” which means you will pay for the cost of that service until you have reached your deductible amount for the plan year.

An out-of-pocket maximum (OOPM) is the maximum dollar amount you would be required to pay for covered medical services during the plan year. Once this maximum amount is reached, you will no longer pay any out-of-pocket costs for co-insurance, deductibles for covered services, copays, or prescription copays. You would still be responsible for the pay-period cost of your insurance benefit.