Understanding Co-Pays, Deductibles & Coinsurance

Co-Pays

A co-pay is usually a set dollar amount that you pay out-of-pocket every time you receive certain medical services.

Prescriptions are the most common medical service that require a co-pay. Below is a partial list of co-pays for services from UnitedHealthcare providers. (For a complete list, see the MPS benefits comparison chart.)

Deductibles- None!

A deductible is an annual dollar amount you have to pay for medical services each calendar year – before insurance pays any benefits. For the UnitedHealthcare HMO plan, there is no deductible.

Coinsurance

Coinsurance is your payment share for a medical service, with your insurance paying the rest of the cost. The coinsurance is a percentage of the bill. For most medical services from UHC providers, your share is 10%.

There is a cap on the total amount you pay per person each year – a maximum of $150.

For a family, the annual coinsurance cap applies to each individual, but if 3 family members reach their coinsurance cap in a year, there are no coinsurance payments for other family members.