Health insurance costs
To understand your health insurance costs, you’ll first need to review your premium amount, deductible, copays, and coinsurance. Knowing how these four elements work together shows what you could pay annually for your health coverage. It can even help you lower health insurance costs and maximize your savings. Let’s get to know each one individually with other ways to get help paying your health insurance costs.
What is a cousin?
The premium is the current amount that you or your employer pay for your health plan to maintain your health coverage. You are responsible for your premium whether or not you use medical services. In most cases, you pay monthly, but you can pay quarterly or annually.
What is a deductible?
A deductible is an amount you must pay toward your health insurance costs before your insurance begins to pay for included services. For example, if you have a $1,500 deductible, the coverage will not pay for some services until you have paid the $1,500. The premium and deductible costs are connected. Generally, the higher the deductible, the lower the premium. The lower the deductible, the higher the premium.
How to choose the premium and deductible
If you know you’ll be using your insurance often, you should choose coverage with a higher premium and lower deductible. This means you’ll pay more each month, but you’ll meet your deductible faster, and your coverage will start paying for included services quickly. In general, you will spend less when you go to the doctor during the year.
The reverse of this is also true. You may want to choose coverage with a lower monthly premium and higher deductible if you know you won’t be using your insurance often. This way your monthly health insurance deductible costs are lower because you may not have to pay the deductible.
What is coinsurance?
Coinsurance is generally a percentage that refers to the amount you must pay for an included service. Does not apply until you meet your deductible.
For example, let’s say it costs $100 to see your doctor. If your coinsurance is 25%, you pay $25 and health insurance pays $75. You must pay the full amount if you have not met the deductible.
What are copays?
Copays are fixed dollar amounts that you may have to pay when you see a doctor or specialist. In most cases, it’s a small amount, like $25 for a doctor’s office visit. However, you will not always have to pay for copays. The amount you pay depends on your health insurance, which specialist you see, and whether he or she participates in the network.
What are the out-of-pocket maximums?
The Out-of-Pocket Maximum (OOPM) is the most you have to pay out of pocket for medical services included in your health plan during the year. In-network deductibles, coinsurance, copayments, and another essential health benefit (EHB) expenses apply to the OOPM.
Low costs. Stay in-network with Provider Finder ®
Before seeking care, be sure to see a doctor or hospital that participates in your health plan’s network. These providers have agreed to work with your health plan and keep your costs low. If you go to a doctor outside of your network, you may have to pay more for their services. In some cases, you may have to pay the full cost. For HMOs, if you are referred to a specialist, make sure the professional is included in your network.
Sign up or log in to Blue Access for Members SM, our secure site for members, to do a personalized search based on your health plan and network.
Get help paying for your health insurance
Under the Affordable Care Act, you can get help paying for your health insurance through one or both of these options:
- Premium Tax Credit – A credit applied to your monthly premium to reduce the amount you pay.
- Help with cost-sharing – A discount that lowers the amount you pay for your deductible, coinsurance, and copays.
To get help paying your health insurance costs, you must:
- Have income that is within a certain range for your household size.
- Not be claimed as a dependent on another person’s annual income statement.
- Buy Silver health coverage on the online Health Insurance Marketplace.
- Not qualify for a government-sponsored program or employer-sponsored health insurance.
See if you qualify for a tax credit. or help with shared expenses. Or you can apply online to get the official results.
No-cost or low-cost health insurance through a government program
Depending on your income and family size, you may be able to get low-cost or no-cost health insurance through a government program, such as the Medicaid Program or the Children’s Health Insurance Program (CHIP).
You can apply online. If you qualify for the Medicaid or CHIP program, the appropriate government office will contact you.
Keep in mind that if you apply for Medicare or CHIP coverage, you won’t be able to use the premium tax credit or cost-sharing discounts. If you are currently covered by the Medicaid Program, you are considered covered under the health care law and do not have to purchase coverage in the online Marketplace.
