Health Insurance Cost : To understand the costs of your health insurance you will first want to know your premium, deductibles, co-payments and co-insurance. Knowing how these four elements work together shows what you could pay annually for your medical coverage. It can even help you reduce health insurance costs and maximize your savings. Let’s know each one individually with other ways to get help paying for your health insurance expenses.
WHAT IS A PREMIUM?
The premium is the current amount that you or your employer pays for your medical expenses insurance in order to maintain your medical coverage. You are responsible for your premium if you use medical services or not. In most cases, it is paid monthly, but can be paid quarterly or annually.
WHAT IS A DEDUCTIBLE?
A deductible is the amount you must pay for your health insurance costs before your insurance begins to pay for the services included. For example, if you have a deductible of $ 1,500, the coverage will not pay for some services until you have paid the $ 1,500. The costs of the premium and the deductible are connected. In general, the higher the deductible, the lower the premium. The lower the deductible, the higher the premium.
How to choose the premium and the deductible
If you know that you are going to use your insurance often, you should choose a coverage with a higher premium and a lower deductible. This means that you will have to pay more monthly, but you will meet the faster deductible and your coverage will begin to pay for the included services quickly. In general, you will spend less when you go to the doctor during the year.
The opposite of this is also true. You may want to choose a coverage with a lower monthly premium and a higher deductible if you know you will not be using your insurance often. This way your monthly medical insurance costs are lower because you may not have to pay the deductible.
WHAT IS CO-INSURANCE?
Coinsurance is usually a percentage that refers to the amount you must pay for an included service. It does not apply until you meet your deductible.
For example, let’s say that going to your doctor costs $ 100. If your coinsurance is 25%, you must pay $ 25 and the medical expenses insurance pays $ 75. You must pay the full amount if you have not met the deductible.
WHAT ARE CO-PAYMENTS?
Copayments are fixed dollar amounts that you may have to pay when you see a doctor or specialist. In most cases, it is a small amount, for example, $ 25 for a visit to a doctor’s office. However, you will not always have to pay co-payments. The amount you pay depends on your medical expenses insurance, which specialist you go to and if he or she participates in the network.
WHAT ARE MAXIMUM OUT-OF-POCKET EXPENSES?
Maximum out-of-pocket costs (OOPM) is the most you have to pay out-of-pocket for the medical services included in your medical expense insurance during the year. Deductibles, co-insurance, co-payments and other essential health benefits (EHB) expenses within the network apply to the OOPM.
LOW COSTS STAY IN THE NETWORK WITH PROVIDER FINDER ®
Before seeking care, be sure to consult a doctor or hospital that participates in your medical insurance insurance network. These providers agreed to work with their medical expenses insurance and keep their 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 HMO , if you are referred to a specialist, make sure that the professional is included in your network.
Enroll or access Blue Access for Members SM , our protected site for policyholders, to do a personalized search based on your medical and network insurance.
Get Help Paying for Your Health Insurance Cost
Under the Affordable Care Act, you can get help paying for your health insurance through one or both of these options:
- Tax credit for premiums: a credit for the monthly premium that reduces the amount you pay.
- Help with shared expenses : A discount that can decrease the amount you pay for your deductible, coinsurance, and co-payments.
To get help paying for your health insurance expenses, you must:
- Have income that is within a certain range for the size of your family group.
- Not be declared a dependent in the annual income statement of another person.
- Buy a medical coverage Silver in the Online Health Insurance Market.
- Do not qualify for a government sponsored program or health insurance sponsored by an employer.
NO-COST OR LOW-COST HEALTH INSURANCE THROUGH A GOVERNMENT PROGRAM
You can make a request online . If you qualify for the Medicaid or CHIP Program, the appropriate government office will contact you.
Please note: If you apply for Medicare or CHIP coverage, you can not use the premium tax credit or the cost sharing discounts. If you are currently covered by the Medicaid Program, you are considered to have coverage under the health care law and do not have to purchase coverage in the Online Marketplace.
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