Three common cost-sharing concepts
Deductible
An amount the member may need to pay for covered services before some plan benefits begin, depending on plan rules.
Copay
A fixed amount that may apply to a particular visit, medication, or service.
Coinsurance
A percentage of an allowed amount that the member may owe after applicable plan rules are applied.
Out-of-pocket limit
A plan-defined limit on certain covered in-network member costs; what counts depends on the plan.
Why simple math can still be wrong
Plans differ in which services are subject to the deductible, how family and individual deductibles interact, whether copays apply before or after a deductible, and which costs count toward limits.
What CareAnything should retrieve later
- Current coverage status
- Plan type
- Remaining deductible when available
- Copay or coinsurance for the service category
- Network level
- Accumulated out-of-pocket information when available
- Service-specific exclusions or limits
These public guides are structured so verified provider, insurer, price, availability, and customer-authorized data can later be inserted from the CareAnything database and APIs without changing the customer journey.