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.
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 amount you pay before your benefits kick in. Some plans have separate medical and pharmacy deductibles. Premiums and copays don't count towards this amount. Copay: The fixed dollar amount you pay for services at a doctor’s office, pharmacy or hospital. Coinsurance: The percentage you pay for services at a doctor’s
office, pharmacy or hospital.
You may qualify for help paying for monthly premiums or your out-of-pocket costs when you receive care. This help is only available for qualifying households enrolled in a Marketplace plan. Do I Qualify?
The Advance Premium Tax Credit is a subsidy that's applied directly to your monthly premiums in advance. Depending on your income and family size, you may qualify. Visit HealthAlliance.org/Individual and use our subsidy tool to see if your household is eligible. If you qualify , cost sharing assistance is only available for Marketplace plans in the Silver metal category .
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.