Learning Center . Learning Insurance . Getting Started with Health Insurance

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Getting started with health insurance

Understanding health insurance costs:

A premium is the monthly payment you make to the insurance company for your health care policy.

#1: Choose a plan with premiums that you can afford every month.

Out-of-pocket costs are NOT included in your monthly premium. This is the amount you must pay during a year for your health care in addition to your premium.

This includes any deductible, co-pay, co-insurance, or extra costs for services.

#2: Find a plan that will help you pay the out-of-pocket costs

  • How much will I pay before the insurance company pays a share?

  • What’s my deductible?

  • How much will I pay to see my doctor or a specialist?

    • What’s my co-pay?

  • What is the maximum amount I pay for health care in a year?

    • What’s the out-of-pocket max?

  • How much will prescriptions cost with this plan?

#3: Before you buy a plan, ask:

There are 3 stages to using your health insurance

Stage 1:

You pay for the full amount for all of your health care bills. After you have paid for care equal to the amount of your deductible, you enter stage 2.

A bilingual infographic explaining that with deductible, you pay all and insurance pays part, while without deductible, insurance is covered after you pay your part, with dollar bills illustrated for each scenario.

Deductible:

The amount you need to pay before the insurance company starts to pay it’s part.

After the deductible is paid, you only pay co-pays or co-insurance.

Stage 2:

You split the cost of care with your insurance company. You only pay for co-pays and co-insurance, and the insurance company pays the rest. After you pay for care equal to the amount of the out-of-pocket max, you enter stage 3.

Co-pay:

The fixed amount you pay for a service each visit.

An infographic explaining the costs of a doctor's visit, including $100 for the visit and $20 copay, with a total payment of $20, and $80 insurance payment.

Co-insurance:

The percentage you pay for a service.

An infographic analyzing medical costs, showing a hospital building icon, and displaying that a doctor’s visit costs $100 with a co-insurance of 30%. It indicates that the user pays $30 and the insurance covers $70.

Stage 3:

You pay nothing and your health insurance pays for all of your covered care. If you don’t get much care during the year, you may stay in stage 1 all year. But, you will need to keep paying your monthly premium to keep your plan.

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You can download a printable PDF of this information

Click the image to download a copy in English and Spanish.

A financial infographic explaining health insurance costs, showing premiums, deductibles, co-pay, and co-insurance with dollar bills and a pie chart.