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Health Care Reform:

Health Insurance & Affordable Care Act

How to Estimate What You'll Spend on Health Care

For many people, it's the main question about health insurance: How much will it cost me? It all depends on the health plan you select, how often you get care, and what kind of care you need. But you can make some reasonable estimates.

Four Ways You Pay

1. Premium. This is what you pay your insurer each month for coverage. It is the most predictable cost you'll have. The amount depends on the particular health plan you select. Multiply your premium amount by 12 to get the yearly cost of your health plan.

  • Typically, the more you pay in insurance premiums, the less you pay in out-of-pocket costs each time you go for medical care.
  • The opposite is also true: The lower the cost of your health plan each month, the more you pay each time you need health care.

2. Deductibles. This is part of your out-of-pocket costs. A deductible is a set amount you must pay before your insurance company helps to pay toward your care. It may be $500, $1,000 or more. 

  • Some plans may have an overall deductible. That means you may need to pay the full cost of doctor visits or medical care you receive until you reach the deductible amount. After you do, the health plan starts paying its portion of covered services. At that point, you will pay for part of your care in the form of copays, co-insurance, or both as outlined by your insurance policy.  
  • Some plans may have different deductible for different types of care. For instance, the plan might start paying toward your health care sooner if you see in-network providers. But, care you get from out-of-network providers, you may need to pay a higher deductible before the plan starts sharing the cost with you.
  • You can generally get certain types of preventive care without having to first meet your plan’s deductible or pay any other costs.

3. Out-of-pocket costs in copayments or co-insurance. How much money you'll spend also depends on how many times you see doctors, buy prescriptions, and receive other types of health care services. For each visit or drug, you may have a copayment or co-insurance.

  • Copays are a flat fee, like $15 for a doctor visit.
  • Co-insurance is a percentage of costs that you pay, such as 30% of a prescription drug cost.

4. Care and supplies that aren't covered by insurance. You'll have to pay the whole cost for services or products that your health plan doesn't cover. These costs may include:

  • Over-the-counter medicines
  • Vitamins and supplements
  • Acupuncture or chiropractic care
  • Fees for providers that are not part of your plan's network


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