With PPO medical plans, you pay a flat dollar amount (a copay) for many services, such as when you visit your primary physician, go to an urgent care clinic, or get a prescription filled. An example of a copay is $25. Copays do not apply to your deductible but will count toward your annual out-of-pocket maximum.
You meet your deductible by paying out of pocket for medical services that require a deductible plus coinsurance until you reach your annual deductible amount. Some services that require deductible and coinsurance are inpatient hospital care, outpatient surgery, x-rays, labs, and diagnostic tests, ambulance services, and durable medical equipment. . Once you have met your deductible, you only pay a percentage amount (your coinsurance) for such services. An example of coinsurance is 20 percent of the allowed amount for a covered service.