Protection from high medical costs
Health insurance provides important financial protection in case you have a serious accident or sickness.
People without health coverage are exposed to these costs. This can sometimes lead people without coverage into deep debt or even into bankruptcy.
It’s easy to underestimate how much medical care can cost:
- Fixing a broken leg can cost up to $7,500
- The average cost of a 3-day hospital stay is around $30,000
- Comprehensive cancer care can cost hundreds of thousands of dollars
Having health coverage can help protect you from high, unexpected costs like these.
How a Marketplace health insurance plan protects you
When you have coverage, your plan protects you from high medical expenses 3 ways:
- Reduced costs after you meet your deductible Once your spending for covered services reaches your plan’s , the plan covers part of your medical expenses. Marketplace plans cover between 60% and 90% of your covered expenses after you’ve met your deductible.
The amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself.
Refer to glossary for more details.
- Example: If your plan has a $1,000 deductible, you pay the first $1,000 in covered services. After that, your plan pays between 60% and 90% of your covered expenses, depending of what kind of plan you have. You pay between 10% and 40% of the costs as or
The percentage of costs of a covered health care service you pay (20%, for example) after you've paid your deductible.
Refer to glossary for more details.
.A fixed amount ($20, for example) you pay for a covered health care service after you've paid your deductible.
Refer to glossary for more details.
- Example: If your plan has a $1,000 deductible, you pay the first $1,000 in covered services. After that, your plan pays between 60% and 90% of your covered expenses, depending of what kind of plan you have. You pay between 10% and 40% of the costs as
- Out-of-pocket maximum This is the total amount you'll have to pay no matter how much covered care you get in a plan year.
- Example: If your plan has a $3,000 out-of-pocket maximum, once you pay $3,000 in deductibles, coinsurance, and copayments the plan pays for any covered care for the rest of the year. This provides important peace of mind and protection from very high medical costs.
- No yearly or lifetime limits Health plans in the Marketplace can't put dollar limits on how much they’ll spend each year or over your lifetime to cover .
A set of 10 categories of services health insurance plans must cover under the Affordable Care Act. These include doctors’ services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more. Some plans cover more services.
Refer to glossary for more details.
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