A health insurance plan that requires a fixed amount to be paid before any benefits in a calendar year is described as which feature?

• A. Coinsurance
• B. Copayment
• C. Calendar year deductible
• D. Out-of-pocket maximum

Answer: (C)

The main concept here is the deductible—the amount you must pay out of pocket before the plan starts paying for covered services. When a plan has a calendar-year deductible, you pay a fixed amount in that year, and only after meeting it do benefits begin to be paid according to the plan’s terms. After you hit the deductible, you may still owe coinsurance or copays for services, and amounts paid toward the deductible typically count toward the annual out-of-pocket maximum. The other terms describe different cost-sharing mechanics: coinsurance is the share you pay after meeting the deductible, copayment is a fixed payment at the time of service, and the out-of-pocket maximum is the cap on what you pay in a year.