The cost of your health care is more than just the premiums that you pay each month. This section of the guide will explain the kinds of costs that you may experience and also some of the calculations involved, to give you a better understanding. This section also offers advice on how to handle unexpected costs and how to understand your bill.
The out-of-pocket maximum is a limit on what you pay out on top of your premiums during a policy period for deductibles, coinsurance and copays. Once you reach your out-of-pocket maximum, your health insurance will pay for 100% of most covered health benefits for the rest of that policy period. The next policy period (plan year), it starts all over again - note: the policy year may not coincide with the calendar year.
Thinking ahead about the health care services that you may need in the…
There are several types of accounts available to help you save on your taxes and manage your medical costs.
Health Savings Account (HSA)
You don’t need to have health coverage through an employer to set up and contribute to an HSA, but you do need to be enrolled in a high deductible health plan that meets Internal Revenue Service (IRS) requirements. For calendar year 2019 the annual limitation for deductible for an individual is $3,500 and for a family is $7,000.. There are other…
Billing mistakes can happen. If the amount on your Explanation of Benefits (EOB) doesn't match the bill from your healthcare provider, take the following steps :
Collect all of the paperwork. Sometimes more than one EOB applies to a single bill.
Compare the codes/descriptions of services from your EOB and your medical bill and make sure that they match and look for duplicate charges.
Review the services to make sure that only services that you received are listed, and that the amount you owe…
If your claim is denied, start with a few basic questions:
Was your insurance coverage in effect at the time of the service?
Was the healthcare service a covered benefit? Was it medically necessary? Learn more.
Was the care provided by an in-network provider?
Were all necessary referrals or preauthorization from your insurance company in place? Learn more.
If you think the services should have been paid, you may want to ask your insurance plan to reconsider. If that doesn’t work, your next…
An Explanation of Benefits (EOB) is a statement that your insurance company sends that summarizes the costs of the health care services you received. This is not a bill. An EOB shows how much your health care provider is charging your insurance company and how much you may be responsible for paying. Closely review your EOB to make sure that it includes only services that you received and that the amount you owe is consistent with your health insurance benefits.
If there are services on your…
Most of the time, you will pay something when you receive medical care. When you and you insurance company each pay part of the cost, it is known as “Cost Sharing”. There are a number of different types of cost sharing, and sometimes you’ll pay more than one for a particular service:
The deductible is the amount you will pay each year (or policy period) for most health care services before your insurance company begins to share the costs.
For example, if your deductible is $500,…
Each insurance company negotiates discounted rates
Health insurance companies rarely pay the full charge for a service; instead, they negotiate the price they will pay for health care services ahead of time. Each insurance company negotiates with health care providers to establish the discounted prices that their members will pay to receive care and services.
So, when you’re choosing a plan you may want to use the Health Costs section of this site to do some comparisons of sample services to…