The Bottom Line
We know the first question you have is how much this will really cost you. That’s why it’s so important to get to know your coverage before you need to use it.
How much will I pay?
When you apply for coverage and make your first month’s premium payment, you are issued a health plan policy with a date that your coverage will start. Each month, you or your employer (for group coverage) pay a monthly amount for your health plan. This is called a premium.
If you purchase your own health plan, you may qualify for help from the government to pay part of your premium. This financial assistance is called an advance premium tax credit or subsidy. The government will send the subsidy directly to the health insurance company. This lowers the cost of your monthly amount owed.
Regardless if you purchase your own plan or get a plan through your employer, you may have to pay part of the cost when you get health care services. This is called your cost-share. Most health insurance plans will have a network, or a list of doctors, hospitals and other health care providers that you can choose from. These are called in-network health care providers. Going to these health care providers when you need care will generally save you the most money. If you go to a provider that is not in your plan’s network, you may have to pay more. Some plans, such as HMO coverage, only cover services by in-network providers. Other plans require that you use exclusive providers (EPO) for certain services, such as prescription drugs or medical equipment.