Cost of medical care has become a growing concern for both patients and providers as the nation’s medical system evolves further.
Health care has become a highly fragmented system where multiple organizational units collaborate in providing care to patients, making it difficult to accurately calculate total costs associated with treating any one individual throughout his or her entire course of treatment.
Premiums
Premiums are an integral component of health care coverage costs. Payment should generally occur monthly to keep coverage active.
Your insurance premiums depend on factors like age, gender and other personal details; each year they renew, these costs tend to increase and become part of your health plan’s cost structure; yet these costs may become confusing, impacting how you decide how to fund health care costs.
According to Kaiser Family Foundation (KFF), in 2020 the average annual premium for single workers was $623; for family coverage this premium totaled $1,7779 according to KFF data.
Deductibles
One way of spreading out the cost of health care services is by paying a deductible amount – usually calculated as a percentage of total charges for services like doctor visits or medication purchases.
Many Marketplace health plans pay for preventive services, like checkups or disease management programs, before your deductible has been met. Your plan details may also specify which payments count toward meeting it – and when they do.
United States citizens typically face two main forms of deductibles in healthcare plans: traditional (applicable to both individuals and family members), and high deductible health insurance plans.
Co-pays
Copays are fixed amounts that you pay at the time of care for health services covered by your health insurance, such as doctor appointments, emergency room visits and specialist consultations.
Copayments may apply when purchasing prescription drugs. They vary based on both drug type and plan; generally speaking, generic versions of name-brand drugs usually have lower copays than their brand-name equivalents.
As the cost of health care continues to increase, insurance companies have implemented copays and cost-sharing measures as a means of offloading costs onto members. Unfortunately, copays have proven a major hindrance when it comes to accessing healthcare – making it more difficult for people when they most require medical help to seek it out.
Co-insurance
Cost is always an important factor when shopping and selecting health plans, so it is crucial that you understand all out-of-pocket costs associated with health coverage including copays, deductibles and coinsurance costs.
Copays are flat fees members pay when receiving health services such as doctor visits, prescription medication or visits to an emergency room. Each insurance plan sets these fees; typically you can find them listed on your health insurance card.
Similar to copays, coinsurance refers to a portion of medical services you pay and your insurer covers; its calculation relies on what’s considered “usual, customary and reasonable” (UCR) pricing of such services; rates may depend on which providers are within your network and should always be verified with your health insurer to ascertain your coinsurance rate.
