Medicare Key Terms

Medicare helps pay, but you will still have costs. Medicare does not pay for all your medical expenses. You will help pay the cost of your care through different types of payments.

Co-Insurance

The cost that you and the health insurance plan pay are split on a percentage basis . for example you might pay 20% of the total allowed cost of service and the plan would pay the remaining 80%.

Co-pay

The fixed amount you pay at the time you receive a covered service. For example, you might pay $20.00 when you visit the doctor or $12.00 when you fill a prescription.

Deductible

A set amount you pay out of pocket for covered services each year before your plan begins to pay.

Out of Pocket Maximum

The maximum amount you pay during a policy period (usually a year). This amount does not include your premium or the cost of any services that are not covered by your plan.

After you reach your out-of-pocket maximum, your plan pays 100% of the allowed amount of covered services for the rest of the policy period.

Premium

The fixed amount you pay your health insurance or plan for Medicare coverage. you may pay your premium to Medicare, to a private insurance company or both, depending on your coverage. most premiums are charged monthly

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