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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 care reform: How much will it cost me? It all depends on how often you get care and what types you need. But you can make some good predictions with the right know-how.

Four Ways You Pay

1. Your cost every month, the premium: This is the most predictable cost you'll have. The premium amount depends on the amount of coverage you get. Multiply your premium amount by 12 to get this yearly cost.

  • Typically, the more you pay for a premium, the less you pay in out-of-pocket costs.
  • The opposite is also true: The less you pay for a premium, 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 pays anything toward your care. It may be $100, $500, or more. 

  • Some plans may have an overall deductible. That means may need to pay the full cost of your health care until you reach the deductible amount. After you do, the health plan starts paying their portion and you pay the copay or co-insurance.  
  • Some plans may have a deductible for only certain types of care. For instance, the plan might start paying toward your health care right away if you see in-network providers. But, if you see out-of-network providers, you may need to pay a deductible before they start sharing the cost with you.
  • You can get preventive care without having to pay the full deductible.

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 get other health care. For each visit or drug, you may have a copayment or co-insurance.

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

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

How to Estimate Your Costs

How often will you see a doctor or need medicine? An educated guess can help you predict these needs -- and what you'll pay for them.

Look back on past expenses. If you keep medical receipts, go through them. Add up your costs for doctor's visits and medicines. Or ask your doctor for a history of your payments over the last year. Your drug store may have a record of your payments for medicine, too.

Use an online calculator. Some web sites -- such as the Health Partners Cost of Care Calculator -- can show you estimated costs based on your state and your current health.

Anticipate your family's health needs. Add in yearly checkups for children, immunizations, and chronic conditions like high cholesterol that need regular blood tests, appointments, or medicine. Include counseling for mental health, too.

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