If a deductible is unmet and a copayment applies, how is the patient’s total financial responsibility determined?

• A. Only the deductible amount
• B. Only the copayment amount
• C. Sum of deductible and copayment
• D. Only the allowed amount

Answer: (C)

When a deductible hasn’t been met, your out-of-pocket cost for a visit includes both the remaining deductible for the year and the fixed copayment for the service. The amount you owe at that encounter is the sum of the remaining deductible plus the copayment. After you’ve paid the deductible portion, the insurer pays the rest of the allowed amount for that service (subject to plan rules).