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The Cost of Health Insurance: It’s More Than Just Your Premium

By November 8, 2021November 15th, 2021Enrollment Featured Health Insurance
Mother and child at a pediatrician appointment.

Choosing a health insurance plan is an important decision. Like with any big purchase, you’ll want to compare how much you pay and what you’ll get in return.

When you’re shopping for a health plan, the “price tag” is the monthly premium. A premium is the amount you pay to your health insurance company to keep your coverage active. But that is only the cost to buy the health plan — what does is it cost to actually use your benefits?

There are several more things to consider beyond the premium:

  • Whether the doctors and hospitals you use are in the network
  • What services and prescription drugs are covered (or not covered)
  • How much your health insurance company pays for covered services you receive
  • How much you’re responsible to pay out of your own pocket for things like doctor visits, prescription drugs, or hospital stays
  • Whether your health plan has a deductible, how high it is, and which services it applies to

How to Find the Best Health Plan for Your Budget

With all these factors to consider, how can you decide which health plan works best for you?

To get started, it’s important to make sure you’re familiar with these common cost-related health insurance terms:

  • Cost-sharing– Cost-sharing is a general term that refers to the amount of money you pay out-of-pocket for health care services that aren’t fully (100 percent) covered by your health insurance company. Cost-sharing includes types of payments called copayments, coinsurance, and deductibles.
  • Copayment– A copayment (or copay) is the set amount you pay for a covered health care service. Your copay is typically due when you receive the health care service and varies by service. For example, the copay for seeing your primary care physician is different from your copay for an emergency room visit.
  • Coinsurance– Coinsurance is the percentage you pay out-of-pocket for some covered health care services. For example, if your coinsurance for radiology services is 20 percent, your health insurance company pays 80 percent of the cost and you pay the remaining 20 percent.
  • Deductible– Your deductible refers to the amount of money you pay out-of-pocket for health care services before your health insurance company starts paying some or all of the costs. Deductibles may only apply to certain health care services and are outlined in your health plan’s Summary of Benefits.

As you’re shopping, you’ll find this information in the Summary of Benefits, a detailed chart that shows all the services the health plan covers and how much it would cost you for each type of service.

Does A Higher Premium Mean I Pay Less Out-of-Pocket?

The simple answer: Sometimes.

Be sure to look at what out-of-pocket costs you’ll pay when you receive services. You’ll also want to think about how much you anticipate using heath care services. If you expect to use them frequently in the plan year, you may want to pick a plan with a higher premium so you can pay less for each service. But if you expect to have a year of good health, it may be more affordable to choose a lower-premium option.

Independence Offers the Most Plan Options

Independence is proud to have served the Philadelphia region for more than 80 years. And we’re the only health insurance carrier in the area to continuously offer coverage on the Health Insurance Marketplace since the start of the Affordable Care Act.

Our 2022 health plans offer you the widest selection, including health plans with no deductible. We can help you find the best plan for your personal health, budget, and preferences.

No matter which Independence Blue Cross health plan you choose, you get:

  • The network with the most doctors and hospitals
  • $0 virtual care options — talk to a doctor, behavioral health counselor, or dermatologist anytime 24/7*
  • Peace of mind knowing you’re covered by benefits from the most popular health plan in the area

Learn more about choosing the right health plan.

*Catastrophic and HSA-qualified plans are excluded from this benefit.
Paula Sunshine

About Paula Sunshine

Paula Sunshine is senior vice president and chief marketing executive at Independence Blue Cross. She oversees all commercial and consumer marketing activities, including digital assets such as and the IBX mobile app. Ms. Sunshine earned a bachelor of arts degree in mathematics from Emory University and a master of business administration from the Wharton School at the University of Pennsylvania.