What Do I Pay for Insurance?
What Is a Monthly Premium?
Your monthly premium is the set amount you pay each month to have your plan. You pay it even if you don’t receive any medical care that month. Like other bills, this premium can rise when it’s time to renew your plan for the next year.
For individual plans, premiums are based on 5-year age ranges. When you enter a new range, your premium will increase on your bill the next month.
What Are Out-of-Pocket Costs?
Out-of-pocket costs are what you must pay when you get care. These costs depend on how much care you actually get and if you have a yearly out-of-pocket maximum. Once you hit that limit, your insurance pays for all of your care. There are 3 types of out-of-pocket costs:
Deductible: The set amount you pay for care before we start helping with the cost. Premiums and copays don't count towards this amount.
Copay: The set fee you pay each time you use a certain medical service covered by your plan. You either pay this or coinsurance.
Coinsurance: The percentage of the cost you pay each time you use a certain medical service covered by your plan. You either pay this or a copay.
Learn more about our Utilization Management Procedures, which let us review coverage of certain services to make sure you're getting the right care at the right time.
Can I Get Help with Costs?
You may qualify for help paying for insurance through the government. Any help you get only helps pay for Public Marketplace plans.
The credit you receive is based on the second-cheapest silver plan available to you. No matter what plan you choose, you'll get the same amount of credit.
What Is the Premium Assistance Tax Credit?
The Premium Assistance Tax Credit is a subsidy that's applied directly to your monthly premiums in advance. You may qualify for it if you:
- Are single and make up to about $46,000
- Are a part of a family of four that makes up to about $95,000
What Is Cost Sharing Assistance?
Cost sharing assistance limits the plan’s maximum out-of-pocket costs and lowers the cost of essential health benefits. You may qualify for it if you:
- Qualify for the premium assistance tax credit and enroll in a silver plan
- Are single and make up to about $29,000
- Are a part of a family of four that makes up to about $59,000
What Are Other Programs That Can Help?
You may also qualify for:
- Medicare for those 65 and older, disabled, or with end stage renal disease
- Medicaid for people with limited incomes
- Children’s Health Insurance Program (CHIP) for children in low-income families