Definitions
This is the amount you pay monthly to have health insurance.
A premium
If you have an 80/20 health insurance plan, the "20" represents your...
co-insurance
Your health care plan has the following co-pays:
- office visits: $20
- specialist visits: $50
- emergency room visits: $150
How much would you need to pay for a routine check-up?
$0 OR $10, depending on your plan
This is the amount you pay for a covered healthcare service before your insurance plan starts to pay.
A deductible
You have to pay this amount every month, regardless of if you use your health insurance services.
A premium
You have not met your $1,000 deductible for the year. You visit an orthopedic specialist to see about knee pain you have been having. Your plan has a co-pay of $50 for specialists. The bill comes out to $476 dollars.
How much do you have to pay?
BONUS: Does the co-pay count toward your deductible?
$526
Bonus: NO, only $476 counts toward your deductible.
This is a set price you pay to your medical provider when you receive services.
A co-pay
This is the total amount of money you may get from your insurance company in a lifetime
A lifetime limit
On the first day of the year, using in-network doctors, you break your leg. You have met your $1,000 deductible on your 80/20 plan.
You incurred the following bills: x-ray of your broken leg ($500) and outpatient surgery to repair the broken leg ($10,000). How much would you pay for the surgery?
$2,100
This is the most you have to pay for covered services in a year
An out-of-pocket maximum
This is a percentage of covered medical expenses that you pay after you’ve met your deductible.
A co-insurance
You forget to check which doctors are in-network before seeing a doctor about migraines. You see a doctor who is out-of-network for your HMO. You have a premium of $43 and a deductible of $2,500. Your plan is 80/20, and you have not met your deductible yet.
You incurred a $1,500 MRI bill. How much do you pay?
BONUS: Explain your math.
$1,500.
BONUS: It's out-of-network for your HMO so you pay the entire cost.
Under this plan, certain doctors may be considered “out-of-network”, meaning care provided by these doctors is not covered.
An HMO
This is a health insurance plan that still allows patients to see providers outside of the network while covering some of the cost.
A PPO
Suppose that under your health insurance policy, hospital expenses are subject to a $1,000 deductible and $250 per day copay. You get sick and are hospitalized for 4 days, and the bill (after insurance discounts are applied) comes to $6,000. How much of that hospital bill will you have to pay yourself?
$2,000