Tips To Maximize Your Health Insurance Plan

Tips To Maximize Your Health Insurance Plan text overlaying image of building blocks showing money going to different points The average person in the United States spends about $3,400 a year on health insurance. If you’re going to spend a lot of money on health insurance, you should make sure you’re getting the most out of it. You’re already paying for the benefits so why not use them and get your money’s worth. To get the most out of your plan you can do things like stay in-network, take advantage of routine screenings, and recommended exams. Use these easy tips to maximize all of the perks in your plan to keep yourself healthy.

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Review Your Plan Annually

You need to know what’s in your plan before you can figure out how to use it. Many people don’t use the benefits of their health insurance policy because they don’t know about them. You know those packets your health insurance company sends you when you start a plan or when it renews? In there is an easy simple to read summary of all your plan’s benefits and perks, you can also create an account of the company’s website to access that summary online. Your health insurance company may do more than just help pay for your care. For example, they may give you savings at the gym or help you deal with your asthma. Don’t pass up any of these extra benefits. Some common perks are:


  • Discounted vision and hearing services
  • Gym memberships
  • Wellness programs
  • Mental health services
  • Telemedicine 

Insurance companies often make changes to benefits and policy terms that take effect when the policy is renewed. So, even if you’ve had the same plan for a long time and you’re pretty sure you know what it covers, take a few minutes to read that summary every year. Going over it could show you new perks or even perks you need taken away. Not to mention, your health changes as you get older so coverage that you didn’t need or care about before might become a deal breaker with that plan.

Things To Consider

You don’t know if rates or perks have changed, so don’t assume it’s the same as the last one. Cost is important, but it shouldn’t be the only thing you think about. You should also think about the provider’s image and the plan’s network.


By paying a premium, you can keep getting the perks listed in your health insurance plan. You can pay it every month, every three months, every six months, or once a year. Premiums for health plans change based on a number of things. There is no perfect amount for a premium, but it must be reasonable all year long. 


Before your health insurance starts to pay for your health care costs, you have to pay a certain amount out of pocket each year. If you need a lot of medical care, a health plan with a low deductible is generally best. If you reach it sooner, your plan will start paying for your costs sooner. However, if you are in good health, a plan with a high deductible may be better because it will save you money on your premium.


A copay is one way that you and your health plan provider share the costs. It means that you have to pay a set amount for each service before you can get it. Your copay depends on what kind of service you need, but it’s usually at least $10. You will always spend the same amount on health care, no matter how much it costs all together. This makes your health costs consistent.


Your network is the group of doctors or other health care providers whose services are covered by your health plan. Most of the time, your source won’t pay for services that aren’t in their network. Check to see if your favorite doctors, clinics, or labs are in the network for your plan. They should be, if possible. If not, you may have to choose between what you want and how much it will cost.

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Carefully Pick Your Primary Care Provider

It’s very important to have a doctor who knows you well, especially over a long period of time. If you don’t have a primary care provider, you end up going to different doctors and clinics when you’re sick. They don’t know what your normal is as far as your vital signs, labs, and medical history. So all they can do is treat the immediate symptoms rather than have a full care plan which you may sometimes need more than just putting a bandaid on your symptoms. A good doctor who knows your family background and your normal vital signs and symptoms. They can help you stay healthy by letting you know about screenings you are qualified for, finding problems before they become big problems, and sending you to a specialist if you need one.


Keep in mind while you’re picking your primary care doctor make sure they’re in-network for your insurance company. No matter what type of plan you have you will always save more money by seeing an in-network provider.

Use Your Plan’s Preventative Care

Even if you have a basic plan with a high premium, you should be covered for any screenings or other “preventive” care you need. This means you don’t have to pay a copay or other out-of-pocket costs. This includes getting tested for diabetes, high cholesterol, and high blood pressure. Most tests for breast cancer and immunizations, such as the flu shot, are also free.

Schedule Procedures Strategically

We know an emergency surgery isn’t something you can plan, but you can be smart about when you schedule visits and procedures. If you can plan ahead for a big medical treatment, there are a few ways to schedule it to get the most out of your health insurance. Some people won’t get a big procedure until they’ve met their deductible. If you don’t have much money saved up, this might make sense.


If you get health care services throughout the year that count toward your deductible and then plan surgery after you’ve met it, it’s more likely that your insurance will pay most of the cost of the surgery and you won’t have to pay a big bill out of pocket. Others who have the money up front might choose to plan a more expensive procedure to meet their deductible early in the year, knowing that the rest of their healthcare costs that year will be covered by insurance.

Save Important Contacts

We can’t always predict when we’ll need quick medical help or to go to the nearest urgent care or emergency room. Costs can be kept down by going to care workers in your network. It’s better to get ready ahead of time. To get started, call your insurance company. Their team will help you figure out where to go or who to call. Put this information in your phone or address book as soon as you have it. So, if you need to ask a question or get to urgent care quickly, you’ll have all the information you need. 


While you’re saving contacts in your phone don’t forget your support team. Your care is made better by the people who help you. Save the important phone numbers for your insurance company, like the member services line and the nurse advice line. This makes it easy to get in touch with them if you need help or answers. Some apps and websites show the email addresses of their support teams, which you can add to your email contacts. Some also have chat functions or pages that you can save for later use. If you can, write down the hours of operation so you know when you’re most likely to get in touch with someone on the support team.

Work With an EZ Agent

It can be hard to figure out your own health insurance because there are so many things to think about. No one likes to spend hours reading about different plan perks and costs, so why not let a professional do all the hard work for free? There is a way to get cheap health insurance without having to go through a lot of trouble. A qualified EZ insurance agent can explain what each plan’s pros and cons are. And help you come up with the plan that works best for you. 


Working with an EZ agent saves you time and stress because you don’t have to try to figure out legal jargon or read small print. Agents do all the hard work, so you can relax knowing that your coverage will meet your financial and medical needs the best. 

Not to mention that EZ agents can save you hundreds of dollars a year on your health insurance bills. We do this by being able to look for the cheapest rates both on and off the market. EZ can also find and use any savings you might be able to get. We don’t just help you find a plan, though. We also help you keep it up to date. EZ can help you make claims with your insurance company and help you renew your policy when it’s time. To get started, just type your zip code into the box below or call 877-670-3557 to talk to one of our certified agents.

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How To Meet Your Deductible

how to meet your deductible text overlaying image of a piggy bank and a stethoscope There are associated costs when enrolling in a health insurance plan. These costs include premiums, coinsurance, and deductibles. The deductible is what we will concentrate on in this article. Your deductible is the amount you pay out-of-pocket before your health insurance starts to pay your covered medical services for the remainder of the year. By “remainder of the year”, we mean that your deductible renews annually. Therefore, it’s important to understand how to meet the deductible before it renews and what happens after you’ve met it.

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What Counts Towards Your Deductible

Not knowing which expenses count toward your deductible could lead you to throwing money away. There are 3 basic things to remember if you want to know what payments count towards it. Any out-of-pocket payment that is:


  • Medically necessary
  • For a service covered by your plan
  • Within your network

To simplify further, the following are some of the medical services you pay that would count towards your deductible:


  • Hospital bills
  • Surgery costs
  • Lab tests
  • MRIs and CAT scans
  • Anesthesia
  • Doctor visits not covered by copays
  • Medical devices such as pacemakers

To give you a real-world example, if you have to have a procedure, you must first pay your deductible before the insurance company will cover the remaining costs. Say the surgery costs $25,000 and your deductible is $2,000. You will pay $2,000 and then the insurance company will pay the remaining $23,000.

What Doesn’t Count Towards Your Deductible

It’s just as important to know which expenses don’t go towards your deductible. This way if you’re keeping track (which you should be) you won’t think you’ve paid more towards your deductible than you actually have. 


A copay is the portion of your medical expense that you are responsible for usually at the time of service. Typically copays are a modest, set amount. For example, you may have a $25 copay every time you visit your primary care physician (PCP). Or you may have to pay $15 every time you fill a prescription. The amount for each service varies depending on your insurance company and plan. Unfortunately these payments don’t count towards your deductible. They do however count towards your out-of-pocket maximum, which is the max amount of money you have to spend on your healthcare in a single benefit year under your plan.


Your coinsurance is another cost-sharing part of your health plan. This is usually shown as a percentage and shows exactly the percent you have to pay and the percent your insurance has to pay after you have met your deductible for the year. For example if you have a 20% coinsurance for a covered service, your insurance company will pay the other 80%. Say you’ve already met your deductible and you need a procedure that costs $1200,with your 20% you pay $240 and your health insurance will pay the remaining $960. Just like with copays, your coinsurance won’t count towards the deductible, but it does count towards your out-of-pocket maximum.


Your premium, as you know, is the amount you pay monthly to keep your health insurance policy active. While your premium and deductible do have a significant relationship, since the lower your premium the higher your deductible and vice versa, it still doesn’t count towards your deductible. Your premium will also not count towards your out of pocket maximum either.

Out-of-network care

Out-of-network care means you went to a provider that is not contracted with your health insurance plan. None of your costs with this provider will go towards your deductible or your out of pocket maximum. The only exception to this rule is if you have a health plan that does have out-of-network coverage such as a Preferred Provider Organization (PPO). A PPO has 2 out of pocket maximums, one that works like every other plans maximum and one specifically for out-of-network services.

Services not covered by your plan

If you get care that your plan does not cover it won’t count towards deductibles or out of pocket maximums either. This can include things like chiropractors, acupuncture, dental, and vision services. 

Family Plan Deductible

Deductibles work differently for individual plans than they do for family plans. A family deductible is the maximum amount that a family must pay out-of-pocket before they start paying coinsurance or copays, rather than the full cost of services. Most family health insurance policies have 2 deductibles. The first being each individual member has their own individual deductible and the second is the overall family deductible. Each time a family member pays towards their own deductible the amount is also credited to the family deductible. If one member meets their individual deductible before the others, then full coverage begins for that person alone, but not for the other family members.


Once the family deductible is met then everyone will receive post-deductible coverage even if not all members met their individual deductible. Family plan deductibles are typically double the amount of an individual plan’s deductible. Although deductibles can vary, it’s uncommon for a family to pay more than the cost of 2 individual deductibles in a single year. This obviously doesn’t apply if each family member has separate policies, as the policies will not coordinate together. 


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High Deductible Health Plans (HDHP)

Whether you have a family plan or an individual plan you have an option with your deductible. A HDHP is not just a plan that appears to have a high deductible, it is a distinct type of health insurance – not just a generic term. A high-deductible health plan is a health insurance policy with a deductible of at least $1,400 for individual coverage or $2,800 for family coverage. These plans also allow you to make contributions to a tax-advantaged Health Savings Account that can help you save money towards your health care. A policy with a high health insurance deductible will save you money on premiums, but you may be responsible for out-of-pocket expenses of up to $8,700 for individual coverage and $17,400 for family coverage.


In recent years, HDHPs have become increasingly popular. This is because they come with lower premiums. However, even though your monthly premium is lower your out-of-pocket medical expenses tend to be a lot more expensive than someone with a LDHP. Low deductible plans come with a higher premium, but medical expenses are lower. If you expect to have very few medical expenses then a HDHP might be right for you. This is because the low premiums combined with a deductible you rarely use may save you more money. LDHP are best for people with chronic conditions or families who expect to have multiple doctor visits per year. This reduces your upfront costs allowing you to manage your expenses easier.

Once You Meet Your Deductible

After you’ve met your annual deductible, your insurance will begin paying its portion of the cost of your covered care for the remainder of the year. After meeting it, your portion of the cost of care will either be a copayment or coinsurance. It’s important to note that any health insurance plans purchased on the Marketplace legally have to cover the cost of some preventative healthcare services even before you meet your deductible. This is for any plan regardless of type or tier. Some of these preventative benefits include:


  • HIV screening
  • Blood pressure screenings
  • Obesity screenings and counseling
  • Lung cancer screenings
  • Fall prevention
  • Tobacco use screenings


  • When does my deductible renew?

Many health insurance plans base their renewal on the calendar year. This means that on January 1st of each year any expenses you have paid towards it are zeroed out. Some health plans may follow a plan year schedule instead. This means that it will renew on the date that your health insurance policy renews in the new year rather than January 1st. Understanding your plan’s deductible schedule can help you avoid unexpected medical costs. For example, if you were planning on waiting until after the holidays to get a medical service, and your plan renews based on the calendar year, you’ll want to rethink that plan. On the other hand, if it renews on your plan renewal date, you may have some wiggle room. 

  • What does “no charge after deductible” mean?

This phrase means that once you meet your deductible the insurance company will cover the full cost of covered medical expenses, up to the plan’s limits. However, most health insurance plans usually only pay 100% of medical costs once you’ve reached your out-of-pocket maximum. 

  • Is my deductible the same as my out-of-pocket maximum?

No, they work similarly in that they serve as a limit to how much you have to pay for your covered medical expenses, but the limits are two different things. Your out of pocket maximum is the most you will pay in one year. Once you’ve met this limit your insurance will cover 100% of all additional covered medical costs for the year in full. Your deductible is how much you pay before your plan begins their cost-sharing feature with you, such as your coinsurance.

Anything that counts towards your deductible also counts towards your out-of-pocket maximum as well. As noted above, there are some costs such as your copays and coinsurance that don’t count towards it, but will count towards your out-of-pocket maximum. Think of your deductible as a milestone, once you reach it you pay significantly less towards your healthcare, reaching your out-of-pocket maximum is the end game once you reach that you pay nothing towards your covered healthcare costs.


Working With EZ

EZ.Insure offers access to local, highly-trained insurance agents who will shop around for the most cost-effective policy. We can save you hundreds of dollars annually by searching for a suitable plan both on and off the Marketplace. We can also determine whether you qualify for local discounts and apply them to your plan. The best part is that we do all of this without charge! Simply enter your zip code into the box below to receive free, instant quotes, or call us at 877-670-3557 to speak with an agent who can answer all of your questions and find you the ideal plan.

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Copay VS Coinsurance: Know The Difference

copay vs coinsurance: know the difference text overlaying image of a filing cabinet with medical bills written on it Health insurance can be confusing. With all the terms like deductibles, premiums, copayments, and coinsurance, some of which people often mistake for each. Those last two – copayments (or copays) and coinsurance – can be particularly problematic when it comes to confusion. Not only that, but many people are not sure when they will be required to pay them, or how they add to their out-of-pocket costs. But simply being aware of the difference between the two, and knowing how they work in your plan, can save time and energy. As well as money that would otherwise be wasted.

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What Are Copays?

A copay is a predetermined amount of money you must pay when you use a medical service at the point of service. Health insurance policies typically specify copayment amounts in advance, and the amount will be different for each type of service. Examples of services that might require copayments include visits to your primary care physician, appointments with a specialist, prescriptions drugs, and emergency room visits. You might, for instance, have to pay $20 each time you see your primary care physician.


After you pay your copayment for a covered service, the insurance company will often pay for the rest. Especially for preventive care. For example, your annual check-up is a service your plan covers. So, you will only be responsible for your copay in this case. You should always check your plan’s benefits summary for specifics. But in general, copays are not included in the calculation of your maximum out-of-pocket costs.

What Is Coinsurance?

Most health insurance plans require that you pay coinsurance, or a percentage of the cost of care. With most plans, you’ll first have to meet your annual deductible. Then your insurance company will begin to cover your care, but you will have to split the cost. Your coinsurance share will depend on your plan, but you might have to pay 20% of each bill, for example. 


In addition, the coinsurance percentage you’ll have to pay may vary depending on the type of medical treatment you receive. For example, you might have to pay a different amount of coinsurance for things like office visits, tests, and medications. 


And, if you have a preferred provider organization (PPO) plan, you’ll most likely have to pay different amounts of coinsurance. Depending on whether or not the healthcare provider you see is in your plan’s network. For example, coinsurance for a primary care physician in your network could be 20%, while coinsurance for a primary care physician outside of your network could be 75%. That means you can lower your out-of-pocket expenses by trying to get care from in-network providers whenever possible. 

How Much Should You Expect to Pay in Coinsurance?

You won’t know exactly how much you’ll end up paying in coinsurance each year, but you can estimate your out-of-pocket costs by thinking about how much care you anticipate needing. The coinsurance you pay on that care will be a chunk of your out-of-pocket expenses, in addition to your monthly premium and your annual deductible. 


Your share of your medical costs will be determined by the type of plan you choose. You can choose from Bronze, Silver, Gold, or Platinum plans, each of which will require that you pay a different percentage of your medical costs:


  • Bronze – 40/60, You pay 40% while your insurer pays the remaining 60%
  • Silver – 30/70, 30% is your responsibility while your insurer pays 70%
  • Gold – 20/80, you pay 20% and your insurer covers 80%
  • Platinum – 10/90, your insurer pays 90% while you cover only 10%


How Copayments and Copays Work

As pointed out above, a copay is a predetermined amount that you have to pay for a covered service at the point of service, but coinsurance is the percentage of the total bill that you are responsible for. Both are some of the out-of-pocket costs of health insurance, but they function very differently. The difference between a copay and coinsurance can be broken down as follows:


  • Copayments are a set price you pay for services. You are responsible for the copays before and after you’ve met your deductible 
  • Coinsurance is a percentage of your medical bills you have. Coinsurance is only charged after you’ve met your deductible for the year.


What this means is that a $20 copay will always be $20. But your 20% coinsurance fee will vary with the price of the service. And these costs, as always, will vary depending on the plan you choose. In general, though, your copayments and coinsurance will be lower if you choose a plan with higher premiums.

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Copay and Coinsurance Example

To make things a little clearer, here’s a further example of how copays and coinsurance work: Let’s say your health insurance plan has a $3,000 deductible, $50 copays for specialists, 80/20 coinsurance, and a $6,000 out-of-pocket maximum on an individual plan (and you have no dependents covered by your plan). This $6,000 maximum means that once you pay that amount in covered medical expenses in a given year, your insurance company will begin to cover everything, and you will no longer have to pay coinsurance. 


Now let’s say you go in for your free annual checkup (a preventative service) and bring up the fact that your shoulder has been bothering you lately. Your primary care physician refers you to an orthopedic surgeon for further evaluation. When you see this specialist, you will pay your $50 copay at the point of service.


The consulted specialist suggests an MRI to evaluate your shoulder pain. The price of the MRI is $1,500, and since you haven’t met your deductible for the year, you will have to pay the whole bill for this test. The MRI finds that you have torn your rotator cuff and will require surgery to repair it. The price tag for this operation is $7,000. After spending $1,500 on the MRI, you will have to pay $1,500 more in order to meet your $3,000 deductible before your insurance will cover any of the surgical costs. That leaves $5,500 to pay for the surgery, and since you have an 80/20 plan, your 20% coinsurance payment would be $1,100. 


With meeting your deductible and paying your coinsurance and copayment, the total cost of repairing your torn rotator cuff would be $4,150. But remember, in this scenario, your plan has a $6,000 out-of-pocket maximum, which you would be close to meeting after this surgery.

What Should You Look for in a Plan?

Since everyone’s financial situations and requirements for health insurance vary, there is no one plan that will work for everyone. But when shopping for a plan, there are some considerations that can help narrow down your options.


For example, if you’re looking at a plan with lower monthly premiums, you’re most likely going to have a higher coinsurance percentage. Take two health care plans with different monthly premiums of $200 and $450 as an illustration. These two plans may have 30% and 20% coinsurance for ER visits, respectively. So, when looking at plans with lower premiums, you should always consider that your out-of-pocket expenses, including your coinsurance payments, might be higher.


And when it comes to the copayments included in the plans that you are looking at, keep in mind that copayments are typically not applied toward meeting deductibles. You should look into plans with lower copays if you anticipate spending a lot of money on prescription drugs. Or making multiple trips to the doctor each year.

In-Network vs Out-Of-Network

As mentioned above, some plans have different deductibles, copayments, and maximum out-of-pocket expenses if you see an in-network healthcare provider than if you see out-of-network providers. This is because doctors and hospitals that are part of your plan’s network have agreed to provide you with care at reduced costs. 


These reduced costs mean that it’s important to seek care from a provider who is part of your insurance’s network if at all possible. And when looking at plans, make sure your preferred doctors and hospitals are included in the plan’s network. If you find that you are frequently seeing out-of-network providers with the plan you have. You might want to make a change to your plan during the next Open Enrollment Period. Speak to an EZ agent about your options.


  • Does coinsurance apply before I meet my deductible?

No, it doesn’t. If you have a 20% coinsurance, they will only begin to cover their 80% after you’ve met your deductible.

  • Do all health insurance plans have copays and coinsurance?

No. You may not be required to pay a copayment for certain medical services with some plans. These plans, however, typically have higher monthly premiums. And there are also catastrophic health plans, for example, with very high deductibles and no coinsurance at all.

  • Are copays and coinsurance tax deductible?

If your out-of-pocket medical expenses exceed 7.5% of your AGI, you may be able to claim a tax deduction for all of your medical expenses. Including your copays and coinsurance. The excess of your healthcare costs over 7.5% of your adjusted gross income is tax deductible.

  • Do copayments and coinsurance count toward out-of-pocket maximums?

Your out-of-pocket maximum includes not only your deductible, but also any copays or coinsurance payments you may have made. Your regular premium payments don’t count toward your maximum.

  • Is it better to have a higher or lower coinsurance percentage included in your plan?

A lower coinsurance percentage means you’ll have to pay less out-of-pocket for covered medical services. But if you have a lower coinsurance percentage, you might have a higher deductible and premiums. 



When you are searching for a health insurance plan, the plan descriptions will always include the premiums (the amount you pay on a monthly basis to maintain the plan), deductibles, copays, coinsurance, and out-of-pocket maximums. Pay close attention to all of these costs, not just the plan’s premiums. So you can get a feel for the true amount you’ll be paying for your healthcare.


If you are generally healthy, a cheaper plan that has higher deductibles could work for you. However, if you expect to have significant healthcare costs, it may be worth it to pay higher monthly premiums for a plan that will cover more of those costs.

EZ Can Help

If you need help finding the right plan for you, EZ.Insure is here to help. We can quickly evaluate all of the health insurance plans in your area. Your personal agent will help you sort through the various plans available to you. And explain all of the costs that come with each one. And the best part is that all of our services are completely free! To get your free quotes, simply enter your zip code in the box below, or give us a call at 877-670-3557.

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The A-Z of Basic Health Insurance Terminology

Diving into the world of health insurance can be intimidating. It’s easy to get overwhelmed when you’re looking for a plan because of all of the jargon and terminology that you need to become familiar with. But knowing what everything means as you research plans will help you to determine which one is best for you and your family, and will ensure you get the best coverage at the best price. Whether this is your first time buying health insurance or not, knowing the following health insurance terminology will help you make a more informed decision.

invoice letter sticking out of an envelope
Actual charge is the dollar amount that is charged by a doctor for a particular medical service. 

Actual Charge

This is the dollar amount that is charged by a doctor or other healthcare provider for a particular medical service or treatment. 


A person that is trained in the mathematical and statistical aspects of the insurance industry. They are the ones who calculate premium rates and assist in estimating the costs and savings of your health insurance plan.

Allowed Amount

Also sometimes called an eligible expense, a payment allowance, or negotiated rates, an allowed amount is the amount that your insurance company is willing to pay for a covered healthcare service. If your provider charges more than the allowed amount, you might have to pay the difference. 

Balance Billing

This is a bill for the amount that you owe for a particular service after insurance has paid its share – in other words, the difference between the actual charge and the allowed amount. For example, if your provider charges you $200 for a service, and the allowed amount is $100, your provider will most likely bill you for the remaining $100. 


This is your share of the cost of a covered healthcare service, calculated as a percent of the allowed amount for the service. You generally have to pay the coinsurance plus any deductible that you owe. For example, if your health insurance plan’s allowed amount is $100 for an office visit and you’ve met your deductible, your coinsurance payment of 20% would be $20 for the visit.

Co-payman's hand holding a blue credit card

This is a fixed amount you pay for covered health care services, such as visits to your doctor, specialists, or any other health care professional. Your co-pay will vary depending on the type of covered healthcare service you receive: visits to a primary care physician, specialist, and the emergency room will all be priced differently.


This is the amount you have to pay each year in medical expenses before your health insurance will kick in and begin to cover the rest of the year’s medical expenses. For example, if your deductible is $2,000,  your plan will not pay anything until you have met your $2,000 deductible for covered healthcare services. 

Drug Formulary

A list of prescription medications that are selected for coverage under a health insurance plan. Prescription drugs can be included on a drug formulary based on their efficacy, safety, and cost-effectiveness. Some plans will place medications on different tiers, which will change the price of the medications. Some health insurance plans may require that patients obtain preauthorization before non-formulary drugs are covered.

Durable Medical Equipment

If you need any medical equipment, such as crutches, oxygen apparatus, wheelchairs, or even blood testing strips for diabetes, your health insurance plan will most likely cover the cost of these things up to a certain point. Generally, you will have to pay coinsurance for any durable medical equipment that you receive. 

High Deductible Health Plan (HDHP)

This type of plan has lower monthly premiums, but a high annual deductible. These plans are generally aimed at people who are healthy and do not go to the doctor often, and so do not expect to have to meet the high deductible. 

In-Network Vs Out-of-Network

netword of people with lines connecting them
Your plan will have a network of healthcare providers, if you see any doctors that are not in your network, you might have to pay out of pocket.

If a healthcare provider is in-network, that means your health insurance plan will cover services provided by them. These are very important terms to know, because if you seek services from a healthcare professional who is considered out-of-network by your plan, you might have to pay for the service completely out-of-pocket. 

Out-of-pocket Limit

This is the most that you will have to pay for medical services during a policy period, which is usually a calendar year. Your premiums and most other medical expenses paid out-of-pocket will count towards your limit, but you should be aware that some plans will not count co-payments, deductibles, or coinsurance, so it’s important to check your policy. 


The amount that you will pay for health insurance every month. Your premium does not include any other expenses. If you do not pay your premium, you will lose your health insurance coverage. 


A healthcare professional that specializes in a certain condition or area of the body. Specialists include gastrologists, dermatologists, and podiatrists, for example. Seeing a specialist will cost more than seeing your primary care physician, so your co-pays and actual charges will be higher. 

UCR (Usual, Customary, and Reasonable)

This is the amount charged for a medical service within a specific geographic area, based on what providers in the area usually charge for the same or similar medical service.

The best way to understand how health insurance works, and to find the right plan for you and your family’s specific needs, is by working with an agent who specializes in health insurance. EZ can help: we offer a wide range of health insurance plans from top-rated insurance companies in every state. And because we work with so many companies and can offer all of the plans available in your area, we can find you a plan that saves you a lot of money – even hundreds of dollars – even if you don’t qualify for a subsidy. There is no obligation, or hassle, just free quotes on all available plans in your area. To get free instant quotes, simply enter your zip code in the bar above, or to speak to a local agent, call 888-350-1890.

Is The Cost Of Health Insurance Your Biggest Problem? Find An Affordable AND Comprehensive Plan With EZ

Looking for a comprehensive health insurance plan but working with a tight budget? You can absolutely find a plan that offers you the coverage you need, while still staying in your price range. But in order to find the plan that offers you the most bang for your buck, you’ll need to understand how much you’ll actually end up spending out-of-pocket for your policy. Don’t worry: that’s what EZ is here for! EZ understands how important it is to find a plan that fits in your budget, but also has the right coverage, so we’ll break down everything that determines the price of your health insurance plan, and we’ll show you how you can find an affordable, comprehensive plan. And we’ll do it all for free, so you can save even more money!

Monthly Premiums

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Your monthly premiums will depend on the type of plan you have and other factors.

One of the main expenses when it comes to your health insurance policy is the monthly premiums. This monthly rate partially depends on the size of your family, your age, and your location, but the amount you pay will also depend on what type of plan you choose. For example, when purchasing a plan on the ACA Marketplace, you’ll have to decide between Platinum, Gold, Silver and Bronze plans, which will affect how much you pay in premiums versus how much of your medical expenses the plan will cover. You’ll also have multiple options when it comes to policy type, like PPO or HMO, which will affect the type of network you have access to. Each type of plan offers different levels of coverage with different monthly premium prices, so the best way to find a policy with a premium that meets your budget but still covers your medical expenses is to work with an EZ agent. Our agents work with the top-rated insurance companies in the country, so we can find you an affordable plan with low monthly premiums.


In order for your plan to start paying its share of costs, you will first have to pay a certain amount out-of-pocket for your care, otherwise known as your deductible. Meeting your deductible is generally where a lot of your money goes when it comes to your policy; for example, your plan might have a $2,500 deductible, which means you will have to pay this amount in medical bills before your insurance company will begin to pay your medical expenses. 

When it comes to health insurance plans, you have the option to choose between a lower deductible or a higher deductible. High-deductible plans have low monthly premiums, so if you are looking to save money, these plans are tempting. But know that if you are in an accident or have a medical emergency, you will have to pay the high deductible before your plan begins to cover you. High-deductible plans are generally more suitable for healthy people who do not need to see the doctor very often; if this is the case for you, one of these plans can save you a lot of money, because your premiums will be lower. Our trained agents can help guide you in the right direction to make sure you are covered completely. 

Copays & Coinsurance

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After meeting your deductible, when you receive medical treatments, you will have to pay a coinsurance.

When budgeting for your health insurance plan, you’ll also have to take into account other expenses in addition to your premiums and deductible: copays and  coinsurance. Copays are a fixed amount you will pay when you see a doctor or specialist and for medications. 

Once you meet your deductible, you will also most likely have coinsurance to pay. This is the amount of money your health insurance company expects you to pay towards your care once they begin contributing. Coinsurance is normally 20% after you meet your deductible. 

Your EZ agent will not only look for plans with lower copays, but they will also go over each plan and break down how things like coinsurance will affect the price of your policy. This means you will know exactly what to expect when it comes to your actual healthcare expenses.

Out-Of-Pocket Maximum

Every plan has an out-of-pocket maximum, which means once you have reached a certain amount of out-of-pocket expenses, your plan will begin to cover everything. For example, if your out-of-pocket maximum is $5,000 and you reach that amount before the year is over, your health insurance plan will pay for all of your medical expenses until the new calendar year begins. We can help you find a plan that has a lower out-of-pocket maximum, so that you’re more likely to end up having your medical expenses fully covered by your plan. This is especially vital if you have a medical condition which requires ongoing treatment: having a plan with a lower deductible and a low out-of-pocket maximum could help you save hundreds of dollars. The key to finding a plan like this is comparing plans with an EZ agent!

We all want to save as much money as we can, especially when it comes to a health insurance plan. Health insurance can be quite expensive, but with professional, highly-trained agents on your side, you can find an affordable plan with the right coverage for your needs. Our agents work with the top-rated insurance companies in the nation, and will compare plans at no cost to you. Health insurance is expensive enough, which is why we offer our services for free. We genuinely want to help you find a great affordable plan, not make money off of you. To get free instant quotes, simply enter your zip code in the bar above, or to speak with a local agent, call 888-350-1890.

Out-of-Pocket Maximum Explained

Medical bills can be a huge source of stress. They can seem like they are never ending, but there is actually a limit on how much you can spend on out-of-pocket healthcare costs. The out-of-pocket maximum, which is the annual limit that you are required to pay for covered health services, is your financial saving grace. Each health insurance plan has different out-of-pocket maximums. Understanding yours will help you get a better handle on how much you will be paying out-of-pocket with your policy. 

What Is an Out-of-Pocket Maximum?caucasian mans hand pointing at the end of a br that says maximum

An out-of-pocket maximum is the amount that you will have to pay for covered health services. Once you reach that amount, your insurance will pay for all covered services. All copayments, deductibles, and coinsurance count towards your out-of-pocket maximum. However, your  monthly premium payments do not go towards your out-of-pocket maximum. 

How It Works

If you need a medical procedure, generally you and your  insurance company will each pay a portion of the cost. You will pay enough to meet your annual deductible, and your insurance company will pay for the rest of the procedure, unless you have to pay coinsurance as part of your policy. If your plan does require you to pay coinsurance then you will also have to pay 20% (usually) of the cost of the procedure, even after meeting your deductible.

After you have met your deductible, you will continue to pay copays and coinsurance until you meet your out-of-pocket maximum. After you meet your maximum, insurance will then pay 100% of any medical costs. You will not have to pay for copays or coinsurance after meeting your maximum. 

calculator on paper with a pen sitting on top of it in the paper.
After you have met your deductible, you will continue to pay copays and coinsurance until you meet your out-of-pocket maximum.

Here’s an example to illustrate how out-of-pocket maximums work. Let’s say Mary has a health insurance plan with a $2,000 deductible, a 20% coinsurance requirement for all care after meeting the deductible, and a $5,000 out-of-pocket maximum. She has to have surgery and the total hospital bill is $20,000. The costs will break down like this:

  • Mary will pay her $2,000 deductible, leaving $18,000 of the bill. 
  • Her coinsurance requirement is 20% of the $18,000, which is $5400. But because Mary’s plan has an out-of-pocket maximum, she and her insurance company will end up each paying part of this cost.
  • Mary has already paid $2,000 to meet her deductible, and her out-of-pocket maximum is $5,000 so instead of owing $5,400 in coinsurance payments, she only owes $3,000 ($2,000 deductible + $3,000 coinsurance = $5,000 maximum out-of-pocket payment). 
  • Her insurance company will now cover the remaining $13,000 of the cost of the procedure.

Do All Plans Have a Maximum?

All plans that meet ACA standards have out-of-pocket maximums. For 2020, that number is $8,2000 for individuals and $16,400 for families. Some plans may have a lower maximum, but none will be higher than those amounts. Plans with higher monthly premiums generally have lower out-of-pocket maximums, while plans with  lower monthly premium plans, like  catastrophic or high-deductible health plans, have higher out-of-pocket maximums. 

In order to find the right plan for your needs and budget, you have to take into account everything that it has to offer, including things like out-of-pocket maximums. Doing all the research alone is time-consuming and can cause confusion and missed opportunities. EZ will make the process quick and painless; we’ll explain everything clearly, give you real-world examples of how the plan would work for you, compare quotes, and calculate costs for you. We will set you up with one agent that will help you find the right plan for your medical and financial needs. To start saving, enter your zip code in the bar above, or to speak to one of our licensed agents, call 888-350-1890.