Manage Your 

Health Care Costs 

FROM COVERAGE TO CARE 
Table of Contents
 


How to Use “Manage Your Health Care Costs” .................................... 3



Understand Your Health Insurance Costs .............................................. 7



My Health Insurance Costs ..................................................................... 10



Plan for health care costs by knowing your income and spending .... 12



How to Pay Your Premium ...................................................................... 15



2 
How to Use “Manage Your Health Care Costs” 
 

A Guide for Assisters



What are the tools? 

1. Understand Your Health Insurance Costs — Defines key terms

to help consumers understand the costs related to having health insurance and

possible savings that may be available to them.

2. My Health Insurance Costs — Consumers can write down contact

information and out-of-pocket costs for their current health coverage.

3. Plan for Health Care Costs by Knowing Your Income and Spending — Many

people don’t think they can afford coverage, and don’t realize financial help may be available. This tool

helps consumers to think about what out-of-pocket health care costs they can afford each month.

Consumers can compare their total income with their total costs, and then get information about applying

for financial help to help reduce costs on the coverage that’s best for them.

4. How to Pay Your Premium —This tool is designed to educate consumers about different

methods of paying for health insurance. Some consumers don’t have bank accounts or live in a cash

economy. This tool will give them possible options to pay for health insurance, even without a bank

account. You can provide this sheet to consumers who ask questions about payment options.

What’s the purpose of these tools? 

Consumers often have questions about how to manage health care costs, and some consumers may be scared 
 

to use their coverage because they’re unsure of the cost of care and if they can afford the care they need. These 
 

tools are designed to help you provide resources to help consumers understand the costs related to health 
 

coverage. Though these tools are mainly for consumers who are unsure if they can afford to use their current 
 

health coverage, those without coverage can benefit as well. 
 

We’re hoping that once consumers start to understand their costs, they’ll begin to benefit from the many services 
 

provided under their plans, like access to primary care and no cost preventive services. 
 

Some of the information in these tools has been adapted from the Consumer Financial Protection Bureau’s (CFPB) 
 

Your Money Your Goals Toolkit. Visit CFPP at consumerfinance.gov/your-money-your-goals/to learn more 
 

about their program and financial planning. 
 

What’s my role as an assister? 

The term Assister, as used in this document, refers to Navigators, Non-Navigator assistance personnel, and 
 

certified application counselors (CACs) in Federally-facilitated Marketplaces.



You may provide these tools to consumers who ask you for help, especially after enrollment as they begin to use 
 

their coverage. You may use this information to help consumers determine the best way to manage health care 
 

costs.



Make sure consumers are clear about your role and how you can help. You shouldn’t provide advice on what 
 

consumers can and can’t afford. Make it clear to consumers that you can’t make financial decisions for them or 
 

provide them with tax or legal advice within your capacity as an assister.
 


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Where can I send consumers for additional help? 

Consumers might need more help or support than these tools alone can give. Below is a referral list template that 

you can fill in and give to consumers to help them contact other resources. This isn’t meant to be a full list of 

resources in your area. You might have to contact your local community action agency, local bank/credit union, 

or housing agency to get a complete list of financial educators (many will be free). Use the third column to add 

your local information. 

Topic Possible Referral Partner 

Local Contact 

Information 

Cash Flow • Financial education provider

Budgeting • Housing counseling agency: makinghomeaffordable.gov/

getstarted/finding-the-right-program/Pages/default.

aspx

• Community action agency

• Nonprofit credit counseling organization

• Tribal organization

• Other community-based nonprofit organization

• Community college

Benefits Screening • Community action agency

• Other community-based nonprofit organization

• Tribal organization

• Community college

• Local social services network

• Social Security Administration: ssa.gov and benefits

management through My Social Security at ssa.gov/

myaccount

Income Tax • Local Volunteer Income Tax Assistance (VITA) site: irs.gov/

Preparation and Individuals/Finda-Location-for-Free-Tax-Prep

Filing • Public library

• Local social services network

Managing Debt • Consumer Financial Protection Bureau (CFPB), Know before

you owe: consumerfinance.gov/knowbeforeyouowe

• CFPB.gov, Paying for college: consumerfinance.gov/

paying-for-college

• CFPB.gov, Mortgage help: consumerfinance.gov/

mortgagehelp

• Legal aid: lsc.gov

• Nonprofit credit counseling organization

• Tribal organization

• Bank or credit union

Dealing with debt • Legal aid: lsc.gov

and collectors • Local pro-bono attorneys’ network or county bar

association legal referral services

• Nonprofit credit counseling organization

5 
Topic Possible Referral Partner 

Local Contact 

Information 

Understanding • Financial education provider

Credit Reports and • Housing counseling agency: makinghomeaffordable.gov/

Scores getstarted/finding-the-right-program/Pages/default.

aspx

• Community action agency

• Nonprofit credit counseling organization

• Bank or credit union

Fixing Errors on • Nonprofit credit counseling organization

Credit Reports and • Financial education provider

Scores • Housing counseling agency: makinghomeaffordable.gov/

getstarted/finding-the-right-program/Pages/default.

aspx

• Community action agency

• Bank or credit union

• Credit Reporting Agencies

Using Financial • Financial education provider

Services • Housing counseling agency: makinghomeaffordable.gov/

getstarted/finding-the-right-program/Pages/default.

aspx

• Community action agency

• Nonprofit credit counseling organization

• Individual development account provider

• Local Bank On or Alliance for Economic Inclusion coalition

• Bank or credit union

Protecting 

Consumer Rights 

• Legal aid lawhelp.org

• State attorney general

Wealth or Asset • my RA, Retirement savings account from the U.S.

Building Department of Treasury: myra.gov/

• Financial education provider

• Housing counseling agency: makinghomeaffordable.gov/

getstarted/finding-the-right-program/Pages/default.

aspx

• Community action agency

• Nonprofit credit counseling organization

• Individual development account provider

• Tribal organization

• Other community-based nonprofit organization

6 
Understand Your Health Insurance Costs
 


There are 3 things to help you understand your health insurance costs before you decide to enroll: 

What you pay, your spending limits, and how you can save. Below are health insurance terms 

related to insurance costs. To learn more about health insurance or get help with more terms, visit 

HealthCare.gov. 

1. What you pay

• 	Premium: The amount you pay for your health insurance every month. For example, you might pay

$100 each month for an individual plan.

• 	Deductible: The amount you pay for covered health care services before your insurance starts to pay.

With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself. Some plans

pay for certain health care services before you’ve met your deductible – for example, all Marketplace health

plans must cover certain preventive services without charging you a copayment or coinsurance, even if you

haven’t yet met your yearly deductible.

• 	Copayment: A fixed amount you pay for a covered health care service (like a doctor’s visit, hospital

outpatient visit, or prescription drugs). This often applies after you’ve paid your deductible. For example,

you might pay a $15 copay for primary care visits and a $35 copay for specialty care visits.

• 	Coinsurance: The percentage of costs of a covered health care service you pay. This often applies

after you’ve paid your deductible. For example, if the health insurance plan’s allowed amount for an office

visit is $100 and you’ve met your deductible, your 20% coinsurance payment would be $20. The health

insurance plan pays the rest.

2. Your spending limits

SAMPLE: WHAT YOU PLAY FOR COINSURANCE 

$100 x .20 = $20 

Specialist cost x 20% coinsurance = Patient cost 

• 	Out-of-pocket limit: The most you have to pay for covered essential health benefits in a plan year.

After you spend this amount on deductibles, copayments, and coinsurance, your health plan pays 100%

of the costs of covered essential health benefits. The out-of-pocket limit doesn’t include your monthly

premiums. It also doesn’t include anything you may spend for services your plan doesn’t cover.

DEDUCTIBLES + COINSURANCE + CO-PAYS =
 


Out-of-pocket limit 

7 
	 

3. How you can save

•		Premium tax credit (PTC): A tax credit you can use to lower the cost of health insurance when

you enroll in a plan through a Health Insurance Marketplace. Eligibility for the premium tax credit is based

on the annual household income and other eligibility information you put on your Marketplace application.

Using projected household income and other eligibility criteria, you may be able to receive advance

payments of the premium tax credit (APTC) that reduce your monthly premiums. If at the end of the year

you’ve received more APTC than you’re eligible for based on your actual annual household income and

other eligibility criteria, you may have to pay back the excess when you file your annual federal tax return.

If you’ve received less APTC than the premium tax credit you qualify for, you may the difference back as a

credit on your federal tax return. Remember to update the Marketplace if your household income or family

size changes, since this may affect your eligibility for APTC and PTC. Visit HealthCare.gov to learn more

about what changes to report.

•		Cost-sharing reduction (CSR): A reduction in the amount you have to pay for deductibles,

copayments, and coinsurance. In a Health Insurance Marketplace, cost-sharing reductions are often

called “extra savings.” Cost-sharing reductions are generally available to eligible enrollees with a household

income up to 250% of the federal poverty level. If you qualify, you must enroll in a plan in the Silver category

to get the extra savings. If you’re a member of a federally recognized tribe, you may qualify for additional

cost-sharing benefits. For more information on Silver plans, please visit: https://www.healthcare.gov/

choose-a-plan/plans-categories/. To review eligibility information, please visit: https://www.healthcare.

gov/lower-costs/.

•		Essential Health Benefits: A set of 10 categories of services health insurance plans must cover

under the Affordable Care Act. These include doctors’ services, inpatient and outpatient hospital care,

prescription drug coverage, pregnancy and childbirth, mental health services, and more. Some plans cover

more services. Plans must offer dental coverage for children. Dental benefits for adults are optional. Specific

services may vary based on your state’s requirements. You’ll see exactly what each plan offers when you

compare plans. To see the full list of essential health benefits that Marketplace plans cover, visit https://

www.healthcare.gov/coverage/what-marketplace-plans-cover/.

•	 Preventive services: Routine health care that includes screenings, check-ups, and patient

counseling to prevent illnesses, disease, or other health problems. Most health plans must cover a set

of preventive services — like certain shots and screening tests — at no out-of-pocket cost to you. This

includes plans available through a Health Insurance Marketplace and is true even if you haven’t met your

yearly deductible. Note: to receive these services at no additional cost, make sure to get them from a

doctor or other provider in your plan’s network. To learn what preventive services are available at no outof-pocket cost to consumers, visit HealthCare.gov/coverage/preventive-care-benefits or review the
 

preventive services resources on the From Coverage to Care website, go.cms.gov/c2c or https://www.
 

healthcare.gov/preventive-care-adults/ for more specifics on covered services.
 

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 _____________________________ 

_____________________________ 

_____________________________ 

My Health Insurance Costs 

Use this worksheet below to keep track of your plan’s information, like plan name and ID number, 

and cost information, like your monthly premium and any savings you qualify for (like a premium tax 

credit). For your convenience, keep this information in a safe place where you can get to it when 

you need it. 

H

H

ealth Insurance Information for Calendar Year 20_ _ 

ealth Plan Information 

Plan Name: _____________________________ 

Plan ID Number: _____________________________ 

Group Number: _____________________________ 

Contact Information: _____________________________ 

Other Notes: _____________________________ 

Health Plan Costs Information 

Monthly Premium: _____________________________



Advance Premium Tax Credit: _____________________________



Deductible: _____________________________



Copayment – Primary Care: _____________________________



Copayment – Specialist Visit: _____________________________



Copayment – Prescription Drugs: _____________________________



Coinsurance (if applicable): _____________________________



Out- of- pocket limit: _____________________________



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12

Plan for health care costs by knowing your 

income and spending 

Are health insurance and health care services something you want but don’t think you can 

afford? Making ends meet can be tough and adding another expense can seem overwhelming. 

Understanding your spending habits could help you find ways to fit in the cost of health insurance, 

like monthly premiums and copayments.

Three steps to help determine what health coverage you 

can afford:

STEP 1

Track your household 

income.

You’ll need this information 

to determine your eligibility 

for 2 kinds of financial help 

in the Marketplace: advance 

payments of the premium 

tax credits and cost-sharing 

reductions. You should always 

apply to determine what you are 

eligible for.

STEP 3 

Shop for plans and 

apply for financial 

assistance. 

Whether you’re renewing 

your current plan, shopping 

for a new plan, or shopping 

for the first time, review plan 

information to be sure you 

chose the best plan. Preview 

Marketplace plans, including 

costs and savings, without 

setting up an account by visiting 

HealthCare.gov/see-plans, or 

contact the Marketplace in your 

State. It takes a few minutes 

and you’ll get an idea how 

much money to set aside each 

month for health care costs.

STEP 2

Know Your Spending 

Costs. 

This will help you as you 

compare plans in the 

Marketplace. You can see which 

plans have out-of-pocket costs 

you can afford, like deductibles, 

premiums, copayments, and 

coinsurance.
1. Track Your Household Income

Use the chart below to track your total monthly household income so you can compare this with your 

monthly spending costs. This will also help you determine if you’re eligible for financial help in the 

Marketplace. Remember to apply for financial help so you’ll know what you may qualify for. 

Income Source 

Week 1 

__/__/__ 

Week 2 

__/__/__ 

Week 3 

__/__/__ 

Week 4 

__/__/__ 

Total 

Job or Self-Employment 

Second job 

Unemployment Compensation 

Social Security Benefit 

Social Security Disability Income 

(SSDI) 

Tax refund 

Other Income 

Totals monthly Income 

Note: When applying for Medicaid, the following are excluded from monthly adjusted gross income (MAGI): 

scholarships, awards, or fellowship grants used for education purposes and not for living expenses; certain 

American Indian and Alaska Native income derived from distributions, payments, ownership interests, real property 

usage rights, and student financial assistance, or an amount received as a lump sum is counted as income only in 

the month received. 

13 
2. Know your spending costs

Use the chart below to track your monthly spending. Then compare this to your monthly income to see 

how much money is available for premiums, copayments, deductible, and other health care costs. 

Category Week 1 Week 2 Week 3 Week 4 Monthy 

Total

 Savings

 Debt payments

 Housing and utilities 

Household supplies and expenses 

Tools of the trade/Job related expenses 

Groceries 

Eating Out 

Pets 

Transportation 

Personal care 

Childcare and school 

Entertainment 

Court-ordered obligations. 

Gifts, donations, other 

Weekly Total 

3. Shop for plans and apply for financial assistance

Visit HealthCare.gov/see-plans to preview plans, including costs and savings, without setting up a 
 

Marketplace account, or contact your State Marketplace.



If you like, apply for financial help to see if you’re eligible for advance payments of the premium tax 
 

credits or cost-sharing reductions.
 


For more information on cash flow budgets, see the CFPB Module 5: Getting through the month. To learn more 

information on financial services that may help you pay your bills, see the CFPB Module 8: Moneyservices, cards, 

accounts, and loans: Finding what works for you. 

14 
How to Pay Your Premium 
 

You must pay your first month’s premium by your health plan’s due date to successfully enroll in your coverage. 

You must also pay your premium every month to stay covered – but each insurance company is different, so pay 

careful attention to their due date. Contact your insurance company if you’re not sure what type of payments your 

plan accepts. 

You may be able to pay your premium one of these 4 ways: 

1. Online: Check your bill or call your insurance company to find out if your plan takes online payment.

Your plan may also mail you online payment instructions. If you enrolled in a plan through HealthCare.gov,

you’ll be taken to your Enroll-To-Do list. If you see a green button that says “PAY FOR HEALTH PLAN,” your

insurance company accepts online payment. Select the green button and you’ll be taken to your plan’s

payment portal where you can pay your premium.

2. Mail: Your insurance company might mail you a bill with instructions for how to pay. Follow the 
 

instructions to submit your payment. 
 

3. Phone: Call your insurance company to see if you can pay over the phone using a credit card, debit

card, prepaid card number, or your bank account information.

4. In person: Some insurance companies have walk-in centers. Contact your insurance company to see

if it has a walk-in center and for locations. Contact information can be found on the back of your insurance

card, or on the company website.

Links about cash payment options, credit counseling, 

and consumer complaints: 

•		Prepaid cards: consumer.gov/articles/1005-prepaid-cards#!what-it-is

•		Bank accounts and Second Chance Bank Accounts: files.consumerfinance.



gov/f/201508_cfpb-ymyg-toolkit-community-volunteers-module-8.pdf



•		If you have a consumer complaint: consumerfinance.gov/complaint

•		Cash: Some insurance companies allow cash payments as a special service at local pharmacies,

convenience stores, or other locations. Contact your insurance company to see if and where cash is

accepted. If you’re only able to pay your premium using cash, you’ll need to contact your insurance

company to ask what type of cash payments they accept. If they don’t accept cash payments, you can

explore other options, like second chance bank accounts or prepaid cards.

Note: If you’re not sure what type of insurance you have, or if you need to pay a premium, contact the number on 

your insurance card. 

15 
go.cms.gov/c2c 

CMS Product No. 11984 

January 2017