KEY WORDS AND PHRASES What You Pay Copayment/Co-insurance The money that you may have to pay $ “out of pocket” for each service you receive. This could include an of昀椀ce visit with a doctor, a prescription medicine, an x-ray, or a hospital stay. If the money you pay is a set amount (for example, a $15 payment to a doctor), it is called a copayment (or copay). If the money you pay is a percentage of the cost of the service (for example, 20 percent), it is called co-insurance. Copayments and co-insurance can vary depending on the kind of service it is and whether you receive it from a provider that is in the plan’s network or not. Many preventive services now do not require copayments or co-insurance. Out-of-Pocket Limit The most you will have to pay each year for care covered by your plan. Once you hit that limit, your insurance starts paying for all of your covered costs.