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Last Updated: March 20, 2023
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What is health insurance?

Similar to how auto insurance covers your automobile if you get into an accident, health insurance covers you if you get sick or injured. It generally covers medical expenses for illnesses, injuries, and conditions, but doesn’t always cover 100% of your costs. Most plans will in fact share costs with you up until a certain point, called the out-of-pocket limit. After you hit the out-of-pocket limit, your health insurance will pay for 100% of your healthcare costs.

Health insurance basics?

Health insurance is necessary for most Americans in order to pay for the high cost of healthcare. Health insurance makes it possible for you to get care when you need and avoid medical bankruptcy. It can protect your life savings from the devastating costs of a major accident, medical emergency, or a chronic disease.

When you’re shopping for a health insurance plan, it’s crucial to know the following terms, so you know how much you’re going to pay for healthcare.

Monthly premiums – Like auto or home insurance, this is the amount of money you pay even if you never make a claim. Think of this as your monthly bill: every month, you pay this premium in order to access your health insurance plan. However, it’s important to note that this is not equivalent to how much you pay on healthcare services. There are plans with lower premiums that have higher out-of-pocket costs.

Deductible – This is the amount of money you must pay before your health insurance coverage kicks in. Deductible amounts can range from $500 a year to $10,000 a year or more. These amounts are typically annual, which means it starts over on January 1^st every year – most plans will still utilize copayments and coinsurance to split costs with you even after the deductible is fully paid.

Copay – This is a fixed amount you pay for a specific service of medication. Copays typically are one of the ways your insurer will split costs with you even after paying your deductible. A typical copay amount is $20 for a doctor visit, $50 for a hospital visit, and $10-$40 for prescriptions.

Coinsurance – The percent you pay for procedures (e.g. surgeries, inpatient stays) For example, if you have a coinsurance of 15%, you will pay 15% of the cost of covered services until you hit your out-of-pocket maximum.

Maximum Out-of-pocket amount – This is the maximum amount of money you will have to pay for covered healthcare services in a year. Deductibles, copays, and coinsurance, all contribute your out-of-pocket limit.