Premium
The amount paid, often monthly, to maintain health insurance coverage, regardless of whether services are used.
Updated
A premium is the amount a policyholder pays to an insurance company to keep coverage in force. Premiums are typically paid monthly and must be paid regardless of whether the patient uses any health care services.
Premiums are separate from cost-sharing amounts such as deductibles, copayments, and coinsurance, which apply only when services are received.
In practice
Premiums are not billed through medical claims and are not patient responsibility on a remittance. In billing workflows, premium payment status is relevant to eligibility verification: lapsed premiums cause coverage termination and claim denials.
Commonly confused with
- Deductible: A deductible is paid when services are used, before the plan pays; a premium is paid to maintain coverage itself regardless of use.