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Out-of-Pocket Healthcare Costs Part 1: Deductibles

image of doctor discussing the patient's health insurance and the deductibles involved in her care

Choosing an insurance plan involves out-of-pocket healthcare costs; however, if you select a plan without being aware of those additional expenses, you may end up switching insurance providers due to budgetary constraints. To help you avoid this, our healthcare experts at My Healthcare Direct have provided our in-depth knowledge regarding deductibles and out-of-pocket healthcare costs.

image of patient speaking with doctor about out of pocket costs and her deductibles

What Are Out-of-Pocket Healthcare Costs?

When it comes to health insurance, there are several outside costs to learn about. These expenses will often make or break which provider you go with. 

Out-of-pocket healthcare costs refer to the portion of your covered medical expenses that you must pay during the course of the policy period. However, they also commonly pertain to in-network costs for essential health benefits, which are required by the Affordable Care Act.

The expenses can include a combination of your health plan’s deductible, copays, and co-insurance for covered, in-network services. 

Types Of Out-Of-Pocket Costs

The following are the most common forms of out-of-pocket healthcare costs:


Deductibles are the amount the consumer must pay for covered services or medications before the insurance plan covers any services.

Essentially, deductibles are a component of cost-sharing. This is the patient’s payment portion for services covered by the health insurance policy. Cost-sharing can also exist in the form of copayments or coinsurance, which most providers incorporate.   

Monthly Premiums

Premiums the amount you must pay for your insurance each month. In addition to premiums, there are typically other costs, depending on the policy.

Copayments & Coinsurance 

Both are payments you make each time you receive care, such as $20 for a doctor’s visit or 30% of hospital care. 

Coinsurance is the percentage you’re responsible for following a covered health care service after you’ve paid your deductible. In comparison, copayments are set rates you pay for doctor’s visits, prescriptions, and other forms of care.

Out-of-Pocket Maximums

Out-of-pocket maximums are the maximum amounts you spend on the plan during the coverage period. Once you reach this limit, the insurance pays 100% for the covered services. 

However, they do not include:

  • Monthly premiums
  • Expenses your plan doesn’t cover
  • Out-of-network care
  • Costs above the allowed amount for a service that a provider may charge

Why You Should Consider Out-of-Pocket Costs Before Selecting Health Insurance 

Before selecting health insurance, it’s vital to consider out-of-pocket costs. If you have a limited monthly budget, you need a policy that fits within those restrictions. This prevents you from overspending or having to switch to another health insurance plan.

Lastly, learning about the outside costs and deductibles enables you to select a plan based on what services or prescription medication you need without incurring unforeseen expenses. For instance, if you have diabetes and require insulin daily, you should select a policy that covers the cost of those medications. 

Receive Free Consultation About Health Insurance Deductibles

With My Healthcare Direct, you can receive professional guidance about out-of-pocket healthcare costs and learn more about deductibles. If you’re experiencing difficulty finding this information, our experts can provide you with the details you need for free. 

Our independent insurance agency proactively services our policyholders using thorough knowledge of the health insurance industry, products, and different obstacles our clients may face. Furthermore, we will evaluate your needs to help you choose the coverage that’s most appropriate for you. 

Please contact us today to consult with one of our insurance agents or ask us any questions! 

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