A deductible is the amount that you have to pay for your health care each year before your insurance starts paying for your care. Similar to car insurance, many health plans require you pay a certain amount out-of-pocket before the coverage kicks in. For example, if you have a deductible of $1500 you have to pay the first $1500 of your medical costs before your insurance starts paying. In some plans the deductible applies only to services that you get outside of the provider network. Also, some plans have a separate deductible for prescription medications. Usual deductible does not apply for preventive services.
An Out-Of-Pocket Limit is the most that you're going to have to pay each year for care covered by your plan. Once you hit that limit your insurance starts paying for all of your covered costs. Now if you have other family members on the same plan they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met as well. Some things that are not counted towards the out-of-pocket limit those can include your premiums, balance billing charges, and health care that the plan does not cover.
The money that you pay out-of-pocket for the services that you receive. This could include anything from an office visit to the doctor, prescription medicine, an x-ray, or even a hospital stay.
Now if the money you pay is a set amount that would be called a co-payment or a copay. If the money that you pay is a percentage of the cost then that would be called coinsurance. Now depending on the plan that you have it dictates whether you have a co-payment/copay or coinsurance.
Health insurance is divided into four main categories. Each category has the name of a metal, the more expensive the metal the more expensive the premium but the richer the benefits. Bronze for example covers 60% of your medical expenses it is also the least expensive premium. Silver covers 70%, Gold covers 80% and Platinum, the most expensive tier, covers 90%.
A health insurance premium is the amount of money you pay per month to the health insurance carrier. Now, you either pay by the month of you pay it per pay period depending if you get it through your employer or not.
If you get it through your employer, your employer most likely covers a portion of your premium.
If you get your insurance through either Covered California or through the exchange in another state then you most likely get an Advance Premium Tax Credit, that's where the Federal Government pays a part of your health insurance premium for you.
If you are not on the exchange and you buy directly through the carrier then you're paying 100% of the premium yourself.
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