Shopping for Health Insurance?
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It's important to understanding the key health insurance costs and how they work together. This will help you find a plan that fits your needs and your budget. On this page, we'll also cover ways you might be able to get help paying for your health insurance costs.
A premium is what you pay monthly, quarterly or yearly for your health insurance plan. Even if you don't get medical care, you still pay the premium.
A deductible is how much you have to pay toward your health insurance costs before your health plan will begin to pay for covered services in a given year. For example, if your deductible is $2,000 for the year, you have to pay for the first $2,000 in medical services. Some plans will pay for certain costs, like preventive services, before you've met your deductible.
Premiums and deductibles work together. Plans with higher deductibles usually have lower premiums, while plans with lower deductibles often have higher premiums. One thing to consider when choosing a plan is how much you think you will use your insurance.
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Coinsurance refers to the percentage of the bill you must pay after you've met your deductible. For example, if it costs $100 to see your doctor and your coinsurance is 20%, you are responsible for paying $20, while your health insurance plan pays $80. If you haven't met your deductible, you will pay the entire $100.
When you see your doctors or other health care professionals, they'll often ask you to pay a copay. This is a fixed dollar amount you're responsible for paying each time you get care. Most insurance plans also require copays for visits to hospitals and other medical facilities.
There is a limit for how much you will have to spend on your health care costs in a year. This is called the out-of-pocket maximum, or OOPM. Your coinsurance, copay, deductible and other in-network essential health benefits apply to the OOPM. Your premium does not count toward the OOPM.
One way to help keep your health insurance costs down is to use only doctors, hospitals and other health care professionals in your plan's network. If you go out of network, you might have to pay the entire bill. Not all plans have the same network. The best way to find in-network providers is by registering or logging into Blue Access for Members, our secure member website, for a personalized search based on your health plan and network using our Provider Finder® tool.
The Blue Cross and Blue Shield of Texas Health Plan Cost Estimator helps you estimate annual health care costs and see plan options.
If your employer gave you an 8-character pass code to access your employer group's Health Plan Cost Estimator tool, enter the code below:
Did you know that under the Affordable Care Act, you might be able to get assistance paying for your health insurance costs? You may qualify for one or both of these options:
To get help paying for your health insurance costs, you must:
Depending on your family size and income, you might be eligible for Medicaid or Children's Health Insurance Program (CHIP). Apply online and you'll be contacted if you qualify. For Medicaid, visit Medicaid.gov . For CHIP, visit insurekidsnow.gov or call 1-877-543-7669.