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Consumer Guide to Health Care


Health Insurance:  Checkup on Costs

There are two main types of costs to think about:
  • How much will the premium cost me each month whether or not I need any health care?

  • How much will I have to pay if I need health care?

Be careful to think about the second question as well as the first because plans with the lowest monthly premiums may end up costing you far more if you actually need health care. These costs can include one or more of the following:

Deductible: the amount you pay for covered services before the health plan begins paying its share.

Coinsurance: the percentage of charges you must pay for each service you receive.

Copayment: a specific dollar amount you must pay for each service you receive.

Also, keep in mind that some plans may put a limit on the amount you are required to pay each year (known as an out-of-pocket limit) but there may be differences on which of your expenses are included in this limit. 

So, think carefully about the different types of health care you currently need or might need in the future.

 

Plan A

Plan B

Plan C

How much will the premium cost me each month?      
If there is a deductible, how much will I have to pay before the plan starts to pay for medical care?      
If there is a deductible, how much will I have to pay before the plan starts to pay for prescription medicines?      
How much will I have to pay (coninsurance or co-payment) for each doctor visit?       
How much will I have to pay (coinsurance or co-payment) for each hospital stay?       
How much will I have to pay (coinsurance or co-payment) for each prescription?       
How much more will I need to pay if I go outside the health plan's network of doctors, hospitals, and other providers to get services?      

This checklist is a modified version of one created by the Agency for Healthcare Research and Quality. Choosing a Health Plan. Your Guide to Choosing Quality Health Care. AHCPR Publication No. 99-0012,  July 2001. Agency for Healthcare Research and Quality, Rockville, MD.

Last Revised: March 27, 2013