October 23, 2023
2 minute read

The basics of health insurance: numbers you need to know

Shopping for health insurance can be overwhelming. Whether it’s your first time or your annual review, knowing the basics can help you effectively compare plans and find coverage that suits your needs and budget. An easy way to start is by understanding the basics of health insurance costs.

Premiums

The premium is the amount you pay, typically each month, for health insurance. This is a fixed price that won’t change throughout the year.

Premiums can change from year to year, even if you make no changes to your plan or coverage. If you already have an insurance plan, make sure to review your renewal notice each year to see if your premium changes.

Deductibles

The deductible is the amount of money you will be responsible for paying for covered medical expenses before your insurance company will begin to pay. After the deductible is met for the year, you split the costs for covered medical expenses through copays and coinsurance.

Many plans cover routine and preventive care, (like vaccinations, annual physicals, or lab work) without requiring you to meet your deductible first. For these services, you may only have to pay the copay.

Premiums and deductibles are directly related

Plans with higher premiums generally have lower deductibles and vice versa. High deductible health plans (HDHPs) can be paired with a health savings account (HSA) that allows you to deposit pre-tax dollars to pay for qualified medical expenses.

Copays and Coinsurance

There are two ways in which you and your health insurance provider may split the cost of your care: copays and coinsurance. A copay is a fixed fee, while coinsurance is a percentage split. Coinsurance begins after you meet your deductible.

Your health insurance company will detail your copay and coinsurance responsibilities in your Summary of benefits document. Keep in mind that they will vary based on your plan, your provider, and the type of service.

Out-of-Pocket Maximum

An out-of-pocket maximum is the most you’ll have to pay during a policy period (usually a year) before your health insurance plan will pay for 100% of covered services. Premiums do not count toward your out-of-pocket maximum, but deductibles, copays and coinsurance are included.

Get down to the basics with HealthMarkets

Don’t let confusion or lack of information stand in the way of making wise health care choices. Let a licensed insurance agent help you understand the basics, compare available plans, and choose coverage that suits your needs and budget. Call (800) 827-9990, or start comparing plans online today.

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© 2023 HealthMarkets Insurance Agency. All rights reserved.

* Medicare Advantage, Medicare Supplemental Insurance, and Part D options can be explored.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.

To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1- 877-486-2048), 24 hours a day/7 days a week). If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance.

Attention: This website is operated by HealthMarkets Insurance Agency, Inc. and is not the Health Insurance Marketplace® website. HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency in all 50 states and DC. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in an insurance plan. No obligation to enroll. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.

HealthMarkets Insurance Agency offers the opportunity to enroll in either QHPs or off-Marketplace coverage. Please visit HealthCare.gov for information on the benefits of enrolling in a QHP. Off-Marketplace coverage is not eligible for the cost savings offered for coverage through the Marketplaces.

This information is not a complete description of benefits. Call the Plan’s customer service phone number for more information.

50351-HM-1023

© 2023 HealthMarkets Insurance Agency. All rights reserved.

* Medicare Advantage, Medicare Supplemental Insurance, and Part D options can be explored.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.

To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1- 877-486-2048), 24 hours a day/7 days a week). If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance.

Attention: This website is operated by HealthMarkets Insurance Agency, Inc. and is not the Health Insurance Marketplace® website. HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency in all 50 states and DC. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in an insurance plan. No obligation to enroll. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.

HealthMarkets Insurance Agency offers the opportunity to enroll in either QHPs or off-Marketplace coverage. Please visit HealthCare.gov for information on the benefits of enrolling in a QHP. Off-Marketplace coverage is not eligible for the cost savings offered for coverage through the Marketplaces.

This information is not a complete description of benefits. Call the Plan’s customer service phone number for more information.

50351-HM-1023

© 2023 HealthMarkets Insurance Agency. All rights reserved.

* Medicare Advantage, Medicare Supplemental Insurance, and Part D options can be explored.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.

To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1- 877-486-2048), 24 hours a day/7 days a week). If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance.

Attention: This website is operated by HealthMarkets Insurance Agency, Inc. and is not the Health Insurance Marketplace® website. HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency in all 50 states and DC. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in an insurance plan. No obligation to enroll. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.

HealthMarkets Insurance Agency offers the opportunity to enroll in either QHPs or off-Marketplace coverage. Please visit HealthCare.gov for information on the benefits of enrolling in a QHP. Off-Marketplace coverage is not eligible for the cost savings offered for coverage through the Marketplaces.

This information is not a complete description of benefits. Call the Plan’s customer service phone number for more information.

50351-HM-1023