With health insurance, it can be confusing on what types of payments you have to make, other than the scheduled premium payments. There are payments you have to make when visiting the doctor, and even when you get prescriptions. First off there is one set payment you will always make to have the health insurance policy itself. It is called the premium, and that is a payment you make to keep an active health insurance policy. If you receive health insurance through your employer, it is likely your premium payment is taken right from your paycheck.

Now just like any other insurance, when you use it you have to pay a deductible before any coverage starts. Since you probably use your health insurance more often for doctor visits and prescriptions, it would be pointless to have to pay a deductible every single time you use it. So deductibles are usually paid once every year to receive coverage. The standard deductibles are usually around $250 a year for a single policy holder, and $500 a year for families. For example, say you went out to get your first prescription of the year, and it cost $50. Your deductible is $250, so you would pay the full $50 of the prescription costs until the costs have totaled to $250. Once you spent the $250 on medical visits or prescriptions, then the insurance would become active.

So once the deductible amount has been spent, your insurance will start to cover some things. Remember the insurance will not always cover 100% of the costs. Depending on which doctors you visit, it can make a huge difference in how much you will pay overall.

There are some doctors that are “in network” with your insurance, which basically means that your insurance company has negotiated a discounted price with that specific provider. So let’s say that you had to have tests done for $100 and your deductibles were already paid for. If the medical center is “in network” with your insurance then they will cover usually around 80% of the cost leaving you to pay only $20 for the tests. Now let’s say it was the same tests, but the medical center is not “in network” with your insurance company. The insurance company will then usually only pay up to 70%, leaving you to pay $30 for the tests. In some cases where the costs for procedures are much more expensive, going to an “in network” provider will save you a lot of money.

The last types of payments are the “out of pocket maximums”, which basically means that if you hit a pre defined price, say $5,000 then you will not have to pay anymore for the rest of the year. So say that you had a severe medical problem that costs $20,000 in medical bills, the most you are going to pay for the year would be your out of pocket maximum usually around $5,000. The last type of payment is your co-pay which is a set price you pay each time you have to visit a doctor, usually around $15 or $20.