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:
- 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.
- 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.
- 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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