What do I have to pay if I get sick or go to the doctor?

Most plans have a few kinds of costs when you get care.

Knowing these helps you plan and avoid surprises.

  • Copay: A set amount you pay at the time of service (for example, $20 for a doctor visit or $10 for a generic prescription).
  • Deductible: The amount you pay each year before your plan pays more. Some services, like certain check-ups, may be covered before you meet the deductible.
  • Coinsurance: A percentage of the bill you pay after you meet your deductible (for example, you pay 20% and the plan pays 80%).
  • Out-of-Pocket Maximum: A yearly limit on what you spend for covered care. After you reach this limit, the plan pays 100% for covered services for the rest of the year.

Check your plan’s Summary of Benefits to see your numbers. If you go to in-network providers and use generic medicines when possible, you can often save money.

For big procedures, ask for an estimate ahead of time. Many clinics can tell you the expected cost before your visit so you can plan.

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