How to Calculate Cost for Your Health Plan

How to estimate costs for your health plan

Sep 05, 2024

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It might be tempting to buy a health plan based with the lowest monthly premium, but if you do, you might be surprised at your costs at the end of the year. So, when you compare plan prices, it’s important to estimate your total yearly costs so you can find a plan that meets your needs and budget.

Here are some things to think about.

Consider what you might need to spend:

The monthly premium, the bill you pay each month. Think of it as a fixed cost.
Deductibles are what you must pay before your plan pays for anything except free preventive services or other no-cost services your plan might offer.
Once you meet your deductible, you still have costs to pay for. You might pay a $25 copay, or fixed amount for a doctor visit. You also pay a share of medical costs called coinsurance, like 40% of a hospital bill, while your plan pays the rest.
Deductibles, copayments and coinsurance add up to an out-of-pocket maximum, or the most you’ll pay in a year. Once you get there, your plan pays 100% for covered services.

The second is how much you need. Each year can be different, but you can get a good idea of how much you might need for you and your family. Consider:

How much did you spend last year? Did you pay more out of pocket than you expected?
Do you have a chronic condition that requires regular doctor visits, medications or treatments?
Are you planning any major costs, like surgery or pregnancy?
Do you take monthly medications? Are any of them expensive? What is the yearly cost? Check to see if the plans you consider cover those medications. (Check Community Health Options list here.)
Are your preferred doctors, hospitals and specialists in the plan’s network? (Check Community Health Options here.)
Do you need dental and vision coverage? Do you or your dependents wear glasses or contacts?
What would it cost you for an unexpected trip to an Emergency Department, serious injury or illness?

Factor in non-medical considerations. If you choose a plan with a high deductible, a Health Savings Account could allow you to lower costs saving some of your income in a tax-free account used to pay for qualified medical expenses. Consult with your broker for which options work best for you.

Want to talk with someone at Community Health Options about which plan to choose? Call us at (855) 624-6463 from 8 a.m. to 6 p.m., Monday through Friday, or email us and we’ll get back to you.

Follow @communityhealthoptions on TikTok for quick tips and tricks on how to buy and use a health plan. And don’t forget to follow Community Health Options on LinkedIn, Facebook or Instagram.

The most important part of a health plan won’t be found in the Schedule of Benefits

Earlier this year, a Community Health Options Member gave birth to a premature baby. Thankfully, the newborn received the best possible care at a big city hospital, but Mom and Dad lived two hours away with two more children to care for, putting incredible strain on the whole family, on top of having a new baby with complex medical needs.

Our care managers began looking for a solution to end the family’s four-hour commute. Once the baby was stabilized and doing well, we worked with the family, the hospital and their pediatrician to move the newborn closer to home, transferring his care to the same pediatrician who would hopefully care for him the rest of his long and healthy childhood.

How to estimate costs for your health plan

The most important part of a health plan won’t be found in the Schedule of Benefits The most important part of a health plan won’t be found in the Schedule of Benefits

The most important part of a health plan won’t be found in the Schedule of Benefits