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Confused By Insurance Terms?

Confused by insurance terms? We've got you covered.

Infographic, key insurance terms everyone should know lg

Related: Health Insurance Terms You Should Know-Part 2 


Monthly bill you pay (or your employer pays for you) for insurance coverage.


You pay this before your plan begins to pay for eligible charges from doctors and facilities.


An upfront fee you pay to a doctor for medical services. Depending on your plan, this may count toward your deductible.

Pharmacy or RX copay

Upfront fee for certain types of drugs.


A percentage of charges that you pay a provider or facility after the deductible has been met (commonly 80/20 coverage).

Total member responsibility

After your insurance carrier has paid their portion of a bill (if applicable), you’re left with this amount. It includes copays, coinsurance, and the deductible.

Out-of-pocket maximum

The maximum amount you will pay toward your deductible, coinsurance, and copays. If you meet the out-of-pocket maximum, eligible services are covered 100% for the rest of the year.


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The content presented here is for your information only. It is not a substitute for professional medical advice, and it should not be used to diagnose or treat a health problem or disease. Please consult your healthcare provider if you have any questions or concerns.

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Post Author

Bobby Macey

Bobby Macey is a marketer and writer by trade. He’s been published nationally and writes on myriad topics—particularly healthy living.