Health insurance protects you from financial events caused by high medical bills. It protects you, but it doesn’t always mean you pay nothing for the health care you receive. Regardless of your insurance coverage, you will be responsible for certain costs related to your care. These are called fees.
If you have health insurance, your plan can cover 100% of preventive services, such as physical exams or checkups. Or it covers part of the cost of travel to the doctor or emergency room. Coverage depends on the specifics of your plan.
Any portion of the health care bill not fully covered or reimbursed by insurance will be paid by you. Depending on your insurance plan, the amount you pay can range from 10% to 100% of the cost of the service.
However, expenses aren’t just incurred when you’re sick or injured. You may face several types of medical expenses.
Here’s everything you need to know about the types of expenses, how to estimate and budget, and how to pay them.
Fees may include the following:
- Extra payment
- Unreimbursed medical expenses
You can search for coupons for your prescription drugs on GoodRx. GoodRx prices may be less than your insurance copay. To see the GoodRx price for your drug:
- Go to goodrx.com.
- Enter your prescription.
- Set your dose, amount and location.
- Compare the coupon price to your insurance company’s cost.
If GoodRx is lower, use the coupon instead of your insurance.
This is the amount you pay each month or year to keep your plan active. If your health insurance is purchased through an employer, you may not pay 100% of your annual premium. However, if you purchased an individual plan or your plan was purchased through an employer group plan, you pay 100% of the annual premium.
Example Scenario: You purchase a $200 per month health plan through the Marketplace. You will incur a monthly out-of-pocket of $200. However, if you have the same plan at work, your employer can split the monthly premium. If your employer contributes $100, your out-of-pocket costs will be $100 per month.
The deductible is determined by your plan. You pay this amount each year for all health services until your health insurance starts paying. Deductibles vary widely based on factors such as coverage, location, and more.
Example Scenario: Let’s say your plan states that your annual deductible is $2,500. This is the amount you will be required to pay out of pocket before your insurance company begins providing reimbursement for health care services.
A copay, or copay, is a fixed amount you pay for every doctor visit, hospital visit, or prescription filled. Not all plans include copays, so these only apply to your plan. Copayments will offset your deductible.
Example Scenario: Your health insurance states that you pay $20 every time you visit the doctor for whatever reason (flu, blood pressure check, wellness exam, etc.). You will be charged $20 per visit.
Once the deductible is met, the insurance company and the individual typically share the cost of health care. This is called coinsurance. Out-of-pocket costs are usually broken down so that the health insurance pays 80% of the cost and you pay 20%, which is called an 80/20 co-pay. However, coinsurance rates can vary from 0% to 30% or more of the insured, depending on the service, insurer, and plan.
Example Scenario: You have paid your annual deductible and go to the doctor for a €100 service. If your coinsurance plan is 80/20, your out-of-pocket cost for that visit will be $20.