The costs of individual healthcare plans in Madison, Wisconsin vary so much because of these 4 factors.

Why Do Out-of-Pocket Costs Vary So Much Between Individual Healthcare Plans?

If you’ve been shopping for individual healthcare plans, you’ve probably noticed big differences between premiums and other costs, such as deductibles and copayments. How do you know what you actually will be paying for a specific service? Several factors determine what you'll be required to pay out-of-pocket, including –


What will my costs be?

How can you estimate what a visit to the doctor will actually cost?  A good place to start is to view the Summary of Benefits and Coverage, which provides the details of an individual health care plan. This document spells out the various out-of-pocket costs, including the deductible, copays, coinsurance and your annual out-of-pocket maximum. It also provides coverage examples to illustrate how much you may pay for certain services. Watch a quick video for help understanding your Summary of Benefits and Coverage document.


If you’re a patient of UW Health, UW Hospitals and Clinics offers the UWHC Priceline phone number, 608.263.1507, to check costs ahead of time.  UW Health also offers a number to call if you want to find out what your potential physician charges may be – 608.829.5637. They will provide a CPT code and the total billed estimate. This is the information you need to provide to your insurance company to find out what your individual health care plan will cover.


In addition, your insurance company may offer a tool to help estimate your out-of-pocket costs. For example, Unity offers an online toolMyChart link or printable form for members to help determine their costs.


Out-of-pocket costs can vary greatly between individual healthcare plans. However, there are many resources to help you estimate the costs of different services based on your situation. If you have questions about what a specific services may cost you, call our helpful customer service representatives at 800.362.3310 for accurate and ​timely information.