Health plans have many moving parts like premiums, co-insurance and deductibles that make it difficult to ascertain costs.
Millions of people pick their health insurance during open enrollment. Consumers are generally locked into their choice for a year.
Your monthly payment may be higher or lower depending on the type of plan you choose, the size of your employer, your geography and other factors. The average patient pays $26 for each visit to a primary-care doctor and $44 to visit a specialty care physician, according to KFF.Patients may owe additional cost-sharing like co-insurance, a percentage of health costs that the consumer shares with the insurer. This cost-sharing generally kicks in after you've paid your annual deductible .
Ninety percent of workers with single coverage have a deductible in 2023, according to KFF. Their average general annual deductible is $1,735.Here's an example based on a $1,000 hospital charge. A patient with a $500 deductible pays the first $500 out of pocket. This patient also has 20% co-insurance, and therefore pays another $100 . This person would pay a total $600 out of pocket for this hospital visit.
"The insurer can't ask you for a co-pay at the doctor or pharmacy, or hit you for more deductibles," Pollitz said. "That's it; you've given your pound of flesh." Here's why that matters: Deductibles and out-of-pocket maximums are much higher when consumers seek care outside their insurer's network — generally about double the in-network amount, McClanahan said."Health insurance really is all about the network," Pollitz said.
"Cheaper plans have skinnier networks," McClanahan said. "If you don't like the doctors, you may not get a good choice and have to go out of network."Budget is among the most important considerations, Winnie Sun, co-founder and managing director of Sun Group Wealth Partners in Irvine, California, previously told CNBC. She's also a member of CNBC's FA Council.
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