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When you have insurance, you pay some costs and your insurance plan pays some others.
Each month, you pay what’s called a premium to have health insurance, even if you do not use any health care services.
Once you’ve paid your premium, most plans help pay for the costs of doctor visits and drugs – you only pay a small
portion or xed amount called a co-pay. Your insurance company won’t pay anything until you use enough health care
services each year to reach what is called a deductible. After that, your plan will cover most of your costs for you, and
you will pay a small percentage called co-insurance.
This amount varies depending on the plan you choose, but a typical plan might cover 80 percent of the costs once you
meet a deductible and you will only pay 20 percent. Usually, you pay a lower monthly premium if you have a higher
deductible. So if you think you and your family will use a lot of health care in a given year, you want a plan with a higher
monthly cost, because it will have a lower overall cost when you add up all of your treatments and medicines.
Out-of-pocket maximum is the most you pay during a policy period, which is usually one year, before your health
insurance or plan starts to pay 100% for covered essential health benets.
The maximum out-of-pocket cost limit for any individual Marketplace plan for 2014 can be no more than $6,350 for an
individual plan and $12,700 for a family plan.
Health insurance words
The most important words are premiums, co-pays, deductibles, co-insurance and out-of-pocket
Premium
Each month, you pay what’s called a premium to have health insurance, even if
you do not use any health care services.
Co-pay
Once you’ve paid your premium, most plans help pay for the costs of doctor
visits and drugs – only making you pay a small portion or fixed amount.
Deductible
It’s the portion you have to pay before the insurance company covers anything.
Co-i
nsurance
After you have met your deducible
, the amount or percent that you have -
usually 20%.
Out-of-pocket
maximum
It’s the most you pay during a policy period (usually one year) before your
health insurance plan starts to pay.