How much does a health insurance plan cost?

A variety of factors influence how much you pay for health care services each month and throughout your insurance coverage period. To help you prepare for the costs of health insurance, we’re breaking down common terms below.

Consider total cost

When shopping for your plan, remember to consider the total cost. Some costs are set fees you pay monthly, while other costs you pay each time you use your insurance. This means that finding the most cost-effective solution often depends on predicting how often you, and if you’re an employer, your employees will use health care services throughout the year. Although no one can predict the future with certainty, it may help you to consider what medical services you used last year and if you think the coming year will be similar. 

 

As you research plans and providers, you’ll encounter a number of terms related to costs that contribute to the financial impact of the plan you choose.

  • Premium: The amount you pay for your insurance each month to maintain coverage, even if you don’t use medical services that month.

  • Copayment, or copay: A specific amount you pay to a provider at the time you receive health care services, products or prescription drugs.

  • Deductible: The amount you pay out-of-pocket to health care providers before your insurance company begins paying for covered health care services.

  • Coinsurance: The percentage you are responsible to pay for certain services and the percentage you pay after you meet your deductible. Once you’ve done those two things, your insurance company pays the rest.

  • Maximum out-of-pocket: This is the maximum amount you’ll pay for health care in a plan year. Your insurance company then pays the full cost of covered charges after this amount.

You should take each of these factors into careful consideration when looking at the total cost of a health care plan.

Expert tips

  • Add your monthly premium to your budget. If you’re an employer, you’ll need to determine if you will be supporting the premium costs for your employees.

  • You may pay copayments each time you go to the doctor or pharmacy, so estimate the number of times a visit or prescription drug will be needed in a year.

  • Under most plans, preventive care like annual checkups, screenings and immunizations are covered at no cost. 

  • Remember to think about budgeting for emergencies, surgeries or unpredictable medical complications that could occur. Because your health insurance is all about managing risk, this is where your deductible, coinsurance and maximum out-of-pocket can provide peace of mind knowing that in the event of an emergency, you have financial protection.

  • While estimating how much medical care you may need, consider your current health and lifestyle. 

  • For detailed cost information about your plan, or a plan you’re considering purchasing, review the summary of benefits and coverage.

     

For Employers: consider your business needs

As an employer, you’ll also want to consider these questions:

  • Do you have a team member to help your employees with ongoing needs or someone to help you navigate coverage?

  • Do you have COBRA (Consolidated Omnibus Budget Reconciliation Act) coverage, an individual health policy or a health plan through the federal Health Insurance Marketplace in place.

  • With Sanford Simplify for Business, we can provide you with a dedicated account manager to answer your questions, assist you with paperwork and COBRA administration, as well as offer guidance whenever you need it.

 

To learn more, request an agent or get a quote. If you're ready to compare plans, click here for our coverage worksheet. You can also call us at (888) 501-4560 to talk to on eof our experts and start setting up your plan.

 

Current Sanford Health Plan members can access their summary of benefits and coverage using our secure member portal or by contacting customer service using the number listed on the back of their member ID card.

 

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