Health Insurance

9 Health Insurance Costs Insurance helps pay for health care. But it does not pay all costs. Usually, you have to pay a share of the costs. Premium: A fee to get and keep insurance. You may pay the whole premium or your employer may pay all or part of it. Premium Assistance: You may qualify for help from the federal government to pay for your premium. You can only get the assistance if you purchase one of the plans offered through Covered California. Visit www.coveredca.com or call 1-800- 300-1506 for more information. Deductible: This is the amount you must pay each year before your insurance begins to pay. Some policies have separate deductibles for prescription drugs and hospital care. Some policies have no deductible. Check your policy to learn how your deductible works. Co-insurance or Co-pay Some policies have a co-pay and some have a co-insurance. Some policies have both. • Co-insurance: This is the part of each bill that you must pay, after you’ve met your deductible. For example, if your insurance covers 80% of the charges for your surgery, you must pay the other 20%. This 20% is called the co-insurance. • Co-pay: This is a flat amount you pay for each visit to a doctor or each prescription, such as $20 for a doctor visit or $15 to fill a prescription. Annual out-of-pocket limit: After you reach this limit, you may not have to pay more co-pays or co-insurance for the year. This limit may not include prescription drugs. Check your policy to learn how this limit works. Yearly and Lifetime Limits (Maximums) Most insurance policies are not allowed to apply yearly or lifetime limits on the benefits you receive.