What Do I Pay for Insurance?

What Is a Monthly Premium?

Your monthly premium is the set amount you pay each month to have your plan. You pay it even if you don’t receive any medical care that month. Like other bills, this premium can rise when it’s time to renew your plan for the next year.

What Are Out-of-Pocket Costs?

Out-of-pocket costs are what you must pay when you get care. These costs depend on how much care you actually get and if you have a yearly out-of-pocket maximum. Once you hit that limit, your insurance pays for all of your care. There are 3 types of out-of-pocket costs:

Deductible: The set amount you pay for care before we start helping with the cost. Premiums and copays don't count towards this amount.

Copay: The set fee you pay each time you use a certain medical service covered by your plan. You either pay this or coinsurance.

Coinsurance: The percentage of the cost you pay each time you use a certain medical service covered by your plan. You either pay this or a copay.

Can I Get Help with Costs?

You may qualify for help paying for monthly premiums or your out of pocket costs when you receive care. Any help you get only helps pay for Public Marketplace plans.

Do I Qualify?

What Is the Premium Assistance Tax Credit?

The Premium Assistance Tax Credit is a subsidy that's applied directly to your monthly premiums in advance. You may qualify depending on your income. Click here to see if you qualify.

If you qualify, premium tax credits are available on any plan on the marketplace, in any metal category.

What Is Cost Sharing Assistance?

Cost sharing assistance limits your plan’s out-of-pocket costs and lowers the cost of essential health benefits. 

If you qualify for savings on your out of pocket costs, you only get the savings if you enrollment in a plan in the Silver metal category.

What Are Other Programs That Can Help?

You may also qualify for:

  • Medicare for those 65 and older, disabled, or with end stage renal disease.
  • Medicaid for people with limited incomes.
  • Children’s Health Insurance Program (CHIP) for children in low-income families.