Health Insurance Simplified
LEARN ABOUT INSURANCE
Confused by health insurance? You're not alone...
Research has shown that 88% of US adults cannot calculate their health insurance costs. 77 million Americans report basic or below basic understanding of health insurance terms and processes. This trend persists no matter one's education level or life experience, affecting people in all walks of life. It also has massive implications on how much we pay for healthcare and how we view medicine as a whole.
We set out to address this problem by defining some of the most common health insurance terms in simple language with real-life examples. Click here to read on.
CALCULATE YOUR COSTS
If you know a few values from your current insurance plan, we can help you calculate what you might pay at the doctor's office, or monthly or yearly for coverage.
Choose "None of the above" if you are being billed for chemotherapy, physical therapy, or other medical services.
The total cost, before any insurance coverage
PLEASE MAKE SURE TO FILL OUT ALL FIELDS WITH AN ASTERISK! IF YOU DON'T KNOW A VALUE, LEAVE IT AS 0.
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SCROLL DOWN TO SEE YOUR RESULTS IN GREEN TEXT!
YOUR Annual Premium Cost:
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Read more about PREMIUMS by clicking below. Annual health insurance costs include your PREMIUM, which is like a subscription fee. You always pay your premium, monthly or yearly, regardless of if you use healthcare or not.
What YOU pay (using the copay model):
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What INSURANCE pays (using the copay model):
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What YOU pay (using the coinsurance model):
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What INSURANCE pays (using the coinsurance model):
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Read more about COPAYS and COINSURANCE by clicking below. Most doctor's visits, prescription costs, and similar healthcare services will ask for a COPAY, which is a fixed amount of the bill you pay while insurance covers the rest. Some plans will instead bill you for COINSURANCE, which is a fixed percentage of the bill you pay.
YOUR Annual Deductible:
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Read more about DEDUCTIBLES by clicking below. Annual health insurance costs also include OUT OF POCKET COSTS. These will vary depending on how often you visit the doctor, a pharmacy, a hospital, or the like. Out of pocket costs include DEDUCTIBLES, COPAYMENTS, and COINSURANCE.
FOR HIGH COST HEALTHCARE EXPENSES (like hospital stays and surgeries, which typically only use coinsurance):
What YOU pay:
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What INSURANCE pays:
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Read more about high cost healthcare by clicking below. Hospital stays and surgeries almost always count towards you DEDUCTIBLE, a fixed minimum you must pay before insurance helps cover these expenses. Given the high cost of hospital stays and surgeries, these almost always bill using COINSURANCE instead of a COPAY.
Read more about OUT-OF-POCKET MAXIMUMS by clicking below. If your DEDUCTIBLE, COPAYS, and COINSURANCE add up over the year to be more than your OUT-OF-POCKET MAXIMUM, then insurance will cover the rest of your costs for that year only.
Keep in mind that these values are only estimates based on information you provide, and are not guaranteed quotes.
Insurance plans are complicated, and we do our best!
COMMON EXAMPLE SCENARIOS
We've created a few people for you to 'meet' in order to understand how health insurance is applied in real-world settings.
MEET JACK
Jack just graduated from high school and doesn't have a job... yet. His options for health insurance include:​​
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Staying on his parents' insurance plan, if their plan accepts dependents, until he turns 26
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Medicaid, if he lives in a state with expanded coverage and falls below the income cap
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The individual insurance marketplace, where subsidies could help him afford a plan if he qualifies
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Attending a college or trade school and applying for a student health insurance program
MEET ROSA
Rosa's family is expanding -- she's having a new baby! But her husband just lost his job and is looking for a new one.
Her options for health insurance include:​​
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Medicaid and CHIP (Children's Health Insurance Program) for Rosa and her kiddos
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COBRA Continuation Coverage to cover her family on their previous insurance plan for up to 18 months
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​Finding a short-term health insurance plan on the marketplace or through a private insurer
MEET TIM
Tim was just diagnosed with a chronic illness... on his 61st birthday, no less.
His options for health insurance include:​​
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Staying on his current plan -- he cannot be denied future coverage due to the new diagnosis
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Considering a new HMO or PPO plan depending on which specialists are in-network and what medications are covered
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Possible additional coverage with a supplemental plan or Medicaid/Medicare, depending on his chronic condition
Please see the Terms and Abbreviations page to see common health insurance terms defined and programs explained.