Health Insurance Costs You Need to Know

by | Nov 13, 2019 | Direct Primary Care, Ridiculous Healthcare Costs | 0 comments

Ok, so you have insurance- what are the key health insurance costs you need to know?  We like to stress that coverage isn’t care, and although insurance is needed as a protection against financial risk, it really should be just that.  Too often, it’s used as a healthcare payment plan, which is one of the big reasons healthcare costs have gotten out of control. This blog will focus on what the costs of a typical health insurance plan are. 

Health Insurance Costs Include:

First, there’s the price you pay just for the privilege of being an insurer’s customer.  That’s the premium. It usually pays for nothing, although some plans to include some care in there (usually some preventive services). 

Then there’s the deductible, which is the amount you are on the hook for when you do access care before the insurer will pay anything. If you are on a family plan you need to determine if you have an embedded or non-embedded deductible. In an embedded plan each individual in the family has a separate deductible they must meet to get coverage for their healthcare expenses. Check out this great article for a deeper dive into family plan deductibles.

You also may have co-pays or per-visit charges associated with your health insurance plan. You will typically find those costs listed on your health insurance card.

Once you’ve reached your deductible, don’t forget about co-insurance, which is a percentage (often 20-30%) of further payments that you “co-insure” with the insurer, until you reach your out-of-pocket maximum.  For an ACA plan from the exchange, the out-of-pocket maximum can be as high $16,400 for a family. And that assumes everything is in-network. Out of network, all bets are off.  

So, insurance costs a lot and often gets you little.  If you’ve forgotten about co-insurance or didn’t get lucky enough to stay in-network, watch out. 

What Can You Do About Healthcare Costs?

When shopping for insurance plans, be wary of narrow networks (even though they lower the premium usually), understand what your maximum out of pocket is, and if it’s too much, look at alternatives – like truly catastrophic plans or health shares. When paired with a direct primary care membership are often much cheaper but offer a higher level of care for the cost that you are paying.

We truly believe that informed consumers make the best decisions particularly when it comes to health insurance costs. Therefore, it is a topic we love to talk about. Check our events page for opportunities to learn more and be sure to follow our blog and our Facebook page. We go live every week to talk about being a great consumer and advocate for your care and your healthcare dollars.


John Hallgren, M.D.

John Hallgren, M.D. is the co-founder of Mission Direct Primary Care in Omaha, Nebraska. He graduated from the Uniformed Services University of the Health Sciences medical school in 1995 and has been a board-certified family physician since completing residency in 1998. He is a 26-year veteran of the U.S. Air Force and has been an assistant professor of family medicine for the University of Nebraska Medical Center and Uniformed Services University. He has several publications in such journals as American Family Physician and The Journal of Family Practice.

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