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Understanding Your Out-of-Pocket Costs

April 19, 2018

If you have health insurance, it’s important that you understand what you’ll pay when you need medications, doctor appointments, tests, or procedures. Remember: having health insurance does not mean that all of your medical costs are automatically covered.

Here are the different kinds of costs you may encounter:

First, there’s the deductible.  A deductible is the amount that you pay out-of-pocket before your insurance will begin to pay for your medical visits or medications. Some plans have high deductibles, but other plans have low or no deductibles. You may not have to pay your deductible before getting some types of services, like visits to your primary care doctor or a specialist.

After you’ve paid your deductible, you may have to pay coinsurance.  This is a set percentage of the cost of your care.  For example: if an x-ray costs $200 and your coinsurance is 20%, you’ll have to pay $40 to get the x-ray (assuming you’ve met your deductible).  Your coinsurance may vary from doctor to doctor, so it’s important to check your plan’s specifics.

Your copay is a set amount that you pay out-of-pocket for each particular medical service you use, like a specialist visit or medication. Copays are set in advance for specific services and medications covered by your plan.

There is a limit to how much you can be charged out-of-pocket.  Once you have reached your plan’s out-of-pocket maximum, then your insurance company pays for all other medical costs for that year.

And remember, everyone gets one free preventative care screening and women get one additional free women’s wellness visit.

To find out what out-of-pocket costs you’ll have to pay, you can visit your plan’s website and see your Summary of Benefits.

We’re happy to walk you through it!  Just contact us at 877-570-3642.