How much will it cost to visit a doctor?

Your share of the cost of health care services (in addition to your monthly payment) is called out-of-pocket costs. There are 3 kinds of costs that you might have to pay:

  1. Deductible. You must pay this amount each policy period (which usually lasts one year) for covered services before your insurance kicks in. You do not pay a deductible until you receive health care services. You may not pay the full amount each year. For example, if your deductible is $1,500, you will pay 100% of your health care costs until you have spent $1,500. Preventive care (such as annual checkups) is free, and does not count toward your deductible.
  2. Copay, or copayment. A copay is a set amount that you pay for health care services. For example, you might have a $25 copay for visits to your doctor, or a $75 copay  for emergency room visits. Copays usually do not count toward your deductible, but check with your plan to be sure.
  3. Coinsurance. Coinsurance is the portion of health care costs that you are responsible for once you’ve met your deductible. It’s usually a percentage, such as 20%. For example, if a doctor visit costs $500 and your co-insurance is 20%, your share is $100.

Your out-of-pocket costs are capped by an out-of-pocket maximum (or out-of-pocket limit), which is the most you will have to pay during a policy period (which usually lasts one year).

The amount of the deductible, copay, coinsurance, and out-of-pocket maximum for your plan is explained in a document called the summary of benefits and coverage. If you have questions, contact your health insurance plan.

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