What You’ll Pay
There are many factors at play when it comes to how much you’ll pay for health insurance —things like your location, age and family size. You can get an estimate of costs by using the Shop and Compare Tool. But how are these costs broken down?
Premiums: Your premium is the bill you get for having a health plan that is usually paid monthly. You or your employer, or both, pay it monthly, quarterly or yearly.
Out-of-pocket costs: a non-reimbursable expense paid by a patient. This could include any medical benefits that a plan doesn't consider "covered services." Your “out-of-pocket maximum” is a limit on how much you’ll have to pay for covered health services in a year. After that, your plan covers 100 percent of costs.
Deductible: The amount you owe for health care services your health insurance plan covers before your plan begins to pay. For example, if your deductible is $1,000, your plan won't pay anything until you have met your deductible for covered health care services. The deductible may not apply to all services.
Copay: A fixed amount (for example, $15) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service.
Coinsurance: Your share of the costs of a covered health care service, calculated as a percentage (for example, 20 percent) of the allowed amount for the service. You pay coinsurance plus any deductible you owe. For example, if the health insurance plan's allowed amount for an office visit is $100, and you have met your deductible for the year, your coinsurance payment of 20 percent would be $20. The health plan pays the rest of the allowed amount.
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