Health insurance requires cost sharing for most services. This means that you must pay for some of your care costs yourself. The terms of your plan will influence how much you usually pay.
Most health plans have coverage networks, which are the groups of physicians and facilities that will accept your plan as a form of payment. When you use an in-network provider, your plan will pay for your care to its fullest extent. Visiting an out-of-network provider will likely cost you more money and some out-of-network care won’t have coverage at all.
Certain care, namely preventive care, might come at no cost to the policyholder.
Many plans include deductibles. A deductible is the cost that you must pay for your own care before your insurer pays for your care. However, many plans waive deductibles for certain care.
Some types of care will have coinsurance requirements. Under a coinsurance rule, your insurer pays for a percentage of your care cost, and you pay the rest. For example, on an 80/20 coinsurance plan, your insurer pays 80% of a medical bill and you pay 20%.
Care services might also include copayments. A copayment is a fee that you pay at the time of receiving care or shortly afterwards. For example, your plan might require you to pay a $30 copayment for a regular checkup while a specialist copayment might be $50.