Managing your Cost / Understanding Your Costs
Prescription drugs
The amounts you pay for prescription drugs covered by your plan would count towards your out-of-pocket maximum. If you purchase a prescription that is not covered by your plan for whatever reason (it’s not on the plan’s formulary, it’s considered experimental, etc.), it would not count.
Not all health plans include prescription coverage, so you may be interested in a stand-alone prescription plan which is available for individual purchase. These plans have a separate…
Managing your Cost / Understanding Your Costs
Deductibles, co-insurance, and co-payments are different ways that you and your plan share the cost when you receive medical care. Learn more. The specifics of each of these cost sharing methods varies from plan to plan, but the following gives a general overview of how they work. See your plan document for specific information.
You pay a deductible each year (or policy period)
With your car or house insurance, when you have a claim you pay the first few (or several) hundred dollars and then…
Managing your Cost / Understanding Your Costs
An Explanation of Benefits (EOB) is a statement that your insurance company sends that summarizes the costs of health care services you received. An EOB shows how much your health care provider is charging your insurance company and how much you may be responsible for paying. This is not a bill. If you owe money, you will receive a separate bill from your health care provider. Individual EOBs are likely to differ from the example provided.
Depicted in EOB statement example above, are these…
Managing your Cost / Understanding Your Costs
A premium is the amount you pay for health insurance every month. Just like your car or home insurance, it’s the amount you pay to the insurance company so that you’re covered―whether you use it or not.
If you receive healthcare coverage through your work, your employer may pay a percentage of your premium, with the rest being deducted from your paycheck (you can review your pay stub or contact your employer for more information).
Premiums can vary quite a bit depending on the details of your…
Managing your Cost / Understanding Your Costs
Balance billing occurs when your out-of-network healthcare provider bills you for the difference between their charges for the service you received and the amount your insurance plan has established as the allowed amount. If your health insurance coverage does not include out of network services, you will be billed for the entire provider charge.
Example
Your doctor charges $6,000 for a surgical procedure. Based on the negotiated contract between your insurance company and the doctor, the…