It's a New Day in Health Care.

Helpful information and links concerning costs.

It's a New Day in Health Care.

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How Health Insurance Works:
Understand the Costs & Benefits

When you start shopping for health insurance, it’s important to know how health insurance works, particularly all the costs involved. Health insurance isn’t pre-paid health care, so even when you have coverage, you pay some of the cost when you get care. How much you pay depends on the health plan you choose.

Premium

This is a set amount you pay for your coverage each month to have health insurance. Paying your premium each month ensures you have coverage when you need it.

Cost-Sharing

When you go to the doctor or get other care, you and your health insurance plan share the cost. This is called cost-sharing. There are different forms of cost sharing, such as copays, coinsurance, deductibles, and other out-of-pocket costs, that you need to know about and consider.

Copays and Coinsurance

Copay/copayment:This is a set dollar amount you pay when you get certain types of care.
Coinsurance: This is a set percentage you pay of the cost of the care you receive.

Deductible

This is a set amount of money you need to pay out of your pocket before your health insurance starts paying part of the cost.

Deductible amounts are different from plan to plan. Some are a few hundred dollars, and some are thousands of dollars. Once you reach your deductible for the year, you pay a lower percentage of your health care costs for the rest of the year while your health insurance pays a larger percentage.

Learn how the various costs affect what you pay for health insurance and health care.

Generally, health insurance plans with higher deductibles, copays, coinsurance and out-of-pocket costs have a lower monthly premium. With these plans you pay more of the cost when you get care, but you pay less on your monthly premium.

Health insurance plans with lower deductibles, copays, coinsurance and out-of-pocket costs usually have a higher monthly premium. Because you pay more each month in a premium, you pay less when you get care.

You get to choose what type of plan is right for you, and we have tools that can help make the choice easier.

How Health Insurance Works: Copays & Coinsurance

DOCTOR VISIT - $100
You PayHealth insurance pays
No health insurance

$100

$0

Health Plan with Copay of $25

$25

$75

Health Plan with Copay of $35

$35

$65

Health Plan with Coinsurance (20%/80%)

$20
(20% of cost)

$80
(80% of cost)

Health Plan with Coinsurance (40%/60%)

$40
(40% of cost)

$60
(60% of cost)

HOSPITAL CHARGE - $6,000
You PayHealth insurance pays
No health insurance

$6,000

$0

Health Plan with $0 deductible & pays 80% of costs

$1,200
(20% of $6,000)

$4,800
(80% of $6,000)

Health Plan with $2,000 deductible & pays 80% of costs after deductible

$2,800
($2,000 deductible + $800 (20% of remaining $4,000)

$3,200
(80% of remaining $4,000 after your $2,000 deductible)

Shop Smart on the Marketplace

Make sure you have all the information you need to choose the right health plan for you.

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But you could still qualify for affordable coverage if you’ve had a life event. These events include marriage, a new child, moving to a new area, losing coverage through your job, and other life changes. See if you qualify!

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How Health Insurance Protects You

Wondering why health insurance is important? You’re not alone. Learn how it protects you – and your wallet.

Why Health Insurance Makes Sense

Why Choose Blue?

We've been there for Tennesseans since 1945 – and we'll be here for you, too.

Why Choose Blue

Facts About the Healthcare Law

Get answers to some of the most commonly asked questions about how the health care law impacts you.

Learn More