Three moving parts
- Copay: Fixed dollar amount for a service (e.g., $10 specialist).
- Deductible: The amount you pay before the plan begins sharing costs.
- Coinsurance: Percentage you pay after meeting the deductible (e.g., 20%).
Out‑of‑Pocket Maximum (OOP)
Your OOP max caps what you’ll pay in‑network in a plan year. After you hit it, the plan pays 100% for covered in‑network care. See our full guide: Understanding Your Out‑of‑Pocket Maximum.
Tip
Don’t pick a plan on premium alone. Balance premium, copays, deductible, and OOP max. True North Roots helps find the sweet spot.
Need help deciding? True North Roots can compare plans, estimate your subsidy, and enroll you at no cost.