When I consider purchasing an individual health insurance plan for myself or my family, do I have any financial obligations beyond the monthly premium and annual deductible? Answers: It depends on the plan, but some plans have the following cost-sharing elements that you should be aware of. Co-Payments: Some plans include a co-payment, which is typically a specific flat fee you pay for each medical service, such as for an office visit. After the co-payment is made, the insurance company typically pays the remainder of the covered medical charges. Deductibles: Some plans include a deductible, which typically refers to the amount of money you must pay each year before your health insurance plan starts to pay for covered medical expenses. Coinsurance: Some plans include coinsurance. Coinsurance is a cost sharing requirement that makes you responsible for paying a certain percentage of any costs. The insurance company pays the remaining percentage of the covered medical expenses after your insurance deductible is met. Out-of-pocket limit: Some plans include an out-of-pocket limit. Typically, the out-of-pocket limit is the maximum amount you will pay out of your own pocket for covered medical expenses in a given year. The out-of-pocket limit typically includes deductibles and coinsurance. But, out-of-pocket limits don’t typically apply to co-payments. Lifetime maximum: Most plans include a lifetime maximum. Typically the lifetime maximum is the amount your insurance plan …
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