Individual and Family Plans

How Does Health Insurance Work? – Understanding Expenses   

Health Insurance Is Confusing! We’re here to help.

Based on the plan you choose, you may have to pay different amounts when visiting a doctor or nurse. When you pay for care, the charges are called “out-of-pocket expenses”. These include –


Copayments (or Copays) – A fixed amount you pay for a covered health care service, usually when you receive the service.

For example, if you have an office visit with your primary care physician (PCP), your copay may be a fixed amount such as $30. If you have a copay, this is usually the only fee you will have to pay when you visit your doctor (other services such as lab tests or x-rays may result in additional fees). Choosing a plan with a copay for services you receive often may help you minimize your out-of-pocket expenses.


Deductible – The amount you owe for health care services before ​your insurance plan begins to pay. For example, if your deductible is $1000, insurance won’t pay anything until you’ve met your $1000 for covered health care services subject to the deductible. The deductible may not apply to all services.


Coinsurance – Your share of the costs of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service. You pay co-insurance plus any deductibles you owe. For example, if your plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your co-insurance payment of 20% would be $20. Your insurance pays the rest of the allowed amount.


Maximum Out-of-Pocket – The most you will pay in calendar year for covered services. This does not include your monthly premium.


In addition to your out-of-pocket expenses, you also pay a monthly fee for your health insurance. This is called your premium.


Understanding Out-of-Pocket Costs


Now that you know all about insurance, find the right plan for you!