How much do health care plans cost?

Finding the right health care plan can feel like a confusing, cumbersome process, but it’s often the most simple, straightforward question that drives our search: How much does it cost?

A number of factors influence how much you’ll pay for health care each month and throughout your plan year. When shopping for your plan, remember to look at total costs. Some costs are set fees that you pay monthly, while others are each time you use your insurance.

As a practical matter, this means that finding the most cost-effective solution often depends on predicting how likely you are to use health care services (and how often you’ll use them) during your plan year.

As you browse various plans and providers, you’ll encounter a number of terms dealing with costs—and understanding them will help you understand the financial impact of the plan you choose. We’ve assembled some of the most common terms below.

  • Premium: The amount you pay for your insurance every month to maintain coverage; or, the fee you pay to the insurance company even if you don’t use medical services that month
  • Copayment, or copay: Specific dollar amount you pay to a provider at the time you receive health care services, products or prescription drugs
  • Deductible: Amount you pay out-of-pocket to health care providers before the insurance company will begin paying for covered health care services
  • Coinsurance: Percentage of costs you are responsible to pay for certain services, and the percentage you pay after you meet the deductible; the insurance company pays the rest
  • Maximum out-of-pocket: This is the maximum dollar amount you’ll pay for health care in a plan year; your insurance company pays all of the costs of covered charges after this amount You should take each of these into careful consideration when looking at the total cost for a health care plan.

Again, in order to estimate the total cost of a health care plan, you’ll need to estimate the medical services you’ll use for the next year. While none of us has a crystal ball to see the future with absolute clarity, one thing that may help you is thinking about how much health care you used last year and if you think next year will be similar.

Some other factors to consider:

  • You will pay your premium every month, so pencil it into your regular budget.
  • You will likely pay copayments each time you go to the doctor or pharmacy, so estimate the number of times you’ll see the doctor or pick up a prescription drug.
    • Under most plans, preventive care like annual checkups, screenings and immunizations are covered at no cost to you.
  • Remember to think about budgeting for any possible emergencies, surgeries or unpredictable medical concerns or complications.
    • This is where your deductible, coinsurance and maximum out-of-pocket come into play. Insurance is all about managing risk. Consider your current health and your lifestyle when assessing your risk for requiring medical care.
  • To get specific information about your plan, or a plan you are considering purchasing, review the Summary of Benefits and Coverage (or SBC) for detailed cost information.

If you are looking for individual or group health insurance, contact us at (888) 535-4831 to get in touch with an agent who can help you through the process, or request a quote at https://www.sanfordhealthplan.org/get-a-quote.

Current Sanford Health Plan members can access their SBC and other plan information in their secure member portals at sanfordhealthplan.com/memberlogin or by contacting customer service at the number listed on the back of your insurance member ID card.