Health plan costs

You shouldn't choose a health plan based only on its monthly rate.  All the potential costs, like deductibles affect your overall costs.

These definitions will help you understand important terms as you shop for a plan.  To see how they affect your premium, check our Plan Selector

Deductible

The annual amount you pay for covered health care services before the plan starts to pay part or all of your costs.  Usually, the higher the plan's deductible, the lower its monthly rate.  You may not use enough medical services in a year to add up to your annual deductible.  But in case you do, make sure you can afford to pay it. 

Coinsurance

A set percentage of a medical expense that you pay after you've met your deductible.  For example, you pay 20 percent and your plan pays 80 percent. Coinsurance is typically 20 to 40 percent of the allowed amount for the service.  The "allowed amount" is what the plan says any medical services should cost. 

Copays

A fixed amount you pay $15 or $20, for each doctor visit or prescription. Not all plans have copays.

Out-of-pocket maximum

The most you will pay in deductible and coinsurance (and copays, if any) for covered services in a year. 

See how insurance works .

Health plan shopping tips?

Before you start comparing plans, a little homework upfront will help you estimate the kind of coverage you need and costs you expect. 

Review the medical care you've received over the past couple of years, and what you've paid for it. 

Use this amount to estimate your heath care costs for an average year.

For each new plan you look at, add up the premiums, deductible payments, coinsurance and other out-of-pocket costs for a year. Make sure you can afford this amount.

You’ll want to consider other services and perks that come with the plan to estimate the plan's real "value" to you.  See what to consider when choosing a plan.

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