These terms all describe money you pay toward health care when you have a health insurance plan.
Copays and coinsurance
A copay is a fixed amount of money you pay for a certain service. Your health insurance plan pays the rest of the cost.
Coinsurance refers to percentages.
Our Medicare Advantage plans use copays for most services.
You pay 20 percent coinsurance for most services with Original Medicare.
A deductible is the amount of money you pay for care before your plan starts paying. For most services, you'll pay the full cost until you reach the deductible. After you reach your deductible, you’ll still have to pay any copays or coinsurance.
Most Medicare Advantage plans have separate medical and pharmacy deductibles. Original Medicare has its own deductibles, but if you have a Medicare Advantage plan, you don't have to worry about them. We pay the Original Medicare deductibles for you.
How they all work together
When you have a Blue Cross plan, we track all the costs you pay – deductible, copays and coinsurance. When you reach a certain amount, we pay for most covered services. This is called the out-of-pocket maximum.
Original Medicare doesn’t have an out-of-pocket maximum. There's no cap on what you pay out of pocket. And if you're in the hospital or a skilled nursing facility, Original Medicare only pays for a certain number of days. After that point, you pay the full amount each day.