Georgia Navigator Practice Exam

What is a fixed dollar amount that an insured must pay for specific covered services at the time they are provided?

1. Deductible

2. Premium

3. Copayment

4. Out-of-pocket maximum

The correct answer is: Copayment

The correct answer is a copayment, which is defined as a fixed dollar amount that an insured individual is required to pay for specific covered services when those services are rendered. Copayments are common in health insurance plans and are often associated with visits to healthcare providers, prescription medications, or specific treatments. This cost-sharing mechanism helps to reduce the overall costs of healthcare for insurers and encourages insured individuals to be more mindful of their usage of health services. For example, an insurance plan may require a $20 copayment for a doctor's visit, meaning that when the insured person receives the service, they will directly pay $20 at the time of the visit, while the insurance pays the remaining balance. In contrast, a deductible refers to the total amount the insured must pay out-of-pocket before insurance coverage kicks in for certain services. A premium is the amount paid periodically to keep the insurance policy active, while the out-of-pocket maximum is the total amount an insured would pay in a year before the insurance covers 100% of costs. Understanding these distinctions is crucial for navigating health insurance effectively.