Understanding Your Costs of Care Under Health Insurance

TUESDAY, APRIL 13, 2021

Understanding Your Costs of Care Under Health Insurance

Everyone knows how expensive health care can be, from the most routine care to cutting-edge treatments. This places a significant cost burden on both providers and their patients. Where patients get the most cost assistance is by using their health insurance. It makes health care astronomically more affordable, proportional to the cost of care.

Still, health insurance doesn’t eliminate the consumer’s cost responsibility altogether. Most plans don’t cover all costs of care with a $0 responsibility from the patient. Usually, you will have to pay certain costs, depending on the care received. Here’s a closer look.

How Health Insurance Requires Payment

All health insurance plans are different, but each will assign different cost responsibilities for different types of care. Some of the factors that determine cost are:

• Your plan’s coinsurance level. Different plans offer different proportions of coverage. For example, some plans will pay for 80 percent of your health care costs while you pay 20 percent. Other plans pay 70 percent while you pay 30 percent.

• The deductible on your coverage. Many plans come with deductibles. This is the cost for your care that you must shoulder on your own. Usually, you pay more for your care before you meet the deductible. After you pay off the deductible, your bills will likely drop. Even so, often, you can still receive certain covered care before paying off the deductible cost.

• Co-payment requirements. Co-payments are small costs that you pay when you go to the doctor. Your co-payment might vary based on the type of care you receive. For example, a primary care visit might cost $30, while a specialist visit might cost $50.

Different types of care are subject to different pricing requirements. For example, regular physicians visits might only be subject to a copayment, whereas hospitalizations and surgeries might face coinsurance and deductible limits. Other services, like vaccinations might be covered at 100%, meaning you pay nothing for these essential, preventive care needs.

Keep in mind, some services won’t have insurance coverage at all. For example, cosmetic surgery is frequently excluded from coverage unless it is medically necessary. If you visit a physician who does not accept your insurance plan either, then that care is unlikely to be covered, either.

Don’t forget, you’ll still have to pay your premium costs as an added expense. This is the bill you pay for your health insurance policy, and you must pay it regularly to be able to continue to receive coverage. Talk to your insurance agent about the costs you will likely pay for your plan. They can help you determine policy is the best for you.