Health Coverage Costs: What You Pay and When
You know you pay a monthly premium to have health coverage. But what else do you pay? Here are the three most common health care costs to help you plan and avoid surprises!
- Monthly Premium
The premium is the amount it costs to have health coverage. You pay part of the total and UC covers the rest. You pay your premium share monthly, whether or not you use services.
A copayment – or copay – is a set fee you pay for each health care service. Medical, pharmacy, emergency, and other specialty care can have different copay amounts.
For example, the copay to see the doctor is $20 while your copay for medicine is $5 for each generic prescription you get from the pharmacy. You pay the copay directly to the provider or pharmacy.
- Out-of-pocket Maximum
Every health plan comes with an out-of-pocket maximum. It's the most you will pay each year for the health services you use.
Copays, coinsurance and deductibles usually count toward the maximum. Your monthly premium does not count, nor do costs for any services your health plan does not cover. It's always a good idea to check your plan coverage so you know how this maximum applies to you.
After you've paid the maximum, Blue & Gold HMO will pay 100 percent of covered services.
Tip! The Summary of Benefits & Coverage for your Blue & Gold HMO plan has all the details about covered benefits. It's a good resource to check when you have questions about what's covered and what you'll pay.