Health insurance helps you pay for routine health care, as well as big medical bills if you have an accident or get very sick. Insurance doesn’t pay for everything – you’ll still have to pay some of your health care costs. The amount you pay depends on your specific health insurance plan. Most health plans include these costs:
- Premiums – The cost you pay for your health insurance, usually every month. You pay your premium even if you don’t get medical care that month.
- Deductibles – The amount you pay out of your own pocket for your covered health care services each year – for example, $1,000. Once you reach your deductible, your insurance plan will begin sharing the cost with you (see coinsurance). A deductible may not apply to all health services, such as preventive care.
- Co-payment (also called co-pay) – A fixed amount you may pay at the time you receive a health care service. For example, you may pay $25 when you go for a doctor visit.
- Coinsurance – Your share of the cost for health care services after you have paid your deductible each year. Once you reach your deductible, the insurance plan will start sharing the cost of health care with you. For example, if you go for a doctor visit that costs $100, your share may be $20 and your insurance plan’s share may be the remaining $80. Coinsurance is usually a percent and depends on your specific insurance plan.
- Out-of-pocket maximum – A limit on your out-of-pocket costs for the year. After you have reached your out-of-pocket maximum for the year, your insurance plan will pay 100% of your covered essential health benefits.
To learn more about financial help to pay for a Marketplace plan, click here.