Health Insurance Costs

It's important to understanding the key health insurance costs and how they work together. This will help you find a plan that fits your needs and your budget. On this page, we'll also cover ways you might be able to get help paying for your health insurance costs.

What Is a Premium?

A premium is what you pay monthly, quarterly or yearly for your health insurance plan. Even if you don't get medical care, you still pay the premium.

What Is a Deductible?

A deductible is how much you have to pay toward your health insurance costs before your health plan will begin to pay for covered services in a given year. For example, if your deductible is $2,000 for the year, you have to pay for the first $2,000 in medical services. Some plans will pay for certain costs, like preventive services, before you've met your deductible.

How to Choose Your Premium and Deductible

Premiums and deductibles work together. Plans with higher deductibles usually have lower premiums, while plans with lower deductibles often have higher premiums. One thing to consider when choosing a plan is how much you think you will use your insurance.

• I will use my insurance often: Do you have small children? Or do you or a family member get sick often or have an ongoing illness or disability? If you think you'll need to see doctors regularly, you may want to consider a plan with a higher premium and lower deductible. You'll pay more each month, but you'll also meet your deductible faster — which means lower total out-of-pocket costs.
• I will not use my insurance often: If you're healthy and don't go to the doctor often, you may want to consider a plan with a lower monthly premium and higher deductible. If you don't think you will meet your deductible with the amount of health care services you may use, a lower premium may be the best way to keep your overall annual costs down.

What Is Coinsurance?

Coinsurance refers to the percentage of the bill you must pay after you've met your deductible. For example, if it costs $100 to see your doctor and your coinsurance is 20%, you are responsible for paying $20, while your health insurance plan pays $80. If you haven't met your deductible, you will pay the entire $100.

Check out our examples of how your coinsurance will work after you've met your deductible.

What Are Copays?

When you see your doctors or other health care professionals, they'll often ask you to pay a copay. This is a fixed dollar amount you're responsible for paying each time you get care. Most insurance plans also require copays for visits to hospitals and other medical facilities.

What Is an Out-of-Pocket Maximum?

There is a limit for how much you will have to spend on your health care costs in a year. This is called the out-of-pocket maximum, or OOPM. Your coinsurance, copay, deductible and other in-network essential health benefits apply to the OOPM. Your premium does not count toward the OOPM.

Take a look at some examples of how your out-of-pocket maximum works with other costs, such as your deductible and coinsurance.

Keep Costs Down. Stay in Network with Provider Finder^®

One way to help keep your health insurance costs down is to use only doctors, hospitals and other health care professionals in your plan's network. If you go out of network, you might have to pay the entire bill. Not all plans have the same network. The best way to find in-network providers is by registering or logging into Blue Access for Members, our secure member website, for a personalized search based on your health plan and network using our Provider Finder^® tool.

Learn more ways to make your insurance work for you.

Get Help Paying for Your Health Insurance Costs

Did you know that under the Affordable Care Act, you might be able to get assistance paying for your health insurance costs? You may qualify for one or both of these options:

1. Cost-sharing assistance. This is a discount that reduces the amount you have to pay toward your deductible, copayments and coinsurance. To use this discount, you must buy a Silver plan.
2. Premium tax credit. This credit goes toward your premium and reduces the amount you pay every month.

To get help paying for your health insurance costs, you must:

• Not qualify for a government-sponsored program or an employer-sponsored health insurance plan.
• Not be claimed as a dependent on someone else's tax return.
• Purchase a plan on the Health Insurance Marketplace.
• Have an income within a certain range.

See if you qualify for the premium tax credit. You can also apply online to get your official results.

Low or No-Cost Health Insurance through a Government Program

Depending on your family size and income, you might be eligible for Medicaid or Children's Health Insurance Program (CHIP). Apply online and you'll be contacted if you qualify. For Medicaid, visit Medicaid.gov . For CHIP, visit insurekidsnow.gov  or call 1-877-543-7669.

You can also learn more about Medicaid plans available through BCBSTX. We offer STAR for individuals and families and CHIP for children who qualify.