Explanation Of Out Of Pocket Costs

Health insurance can be confusing. We’re here to help. Here’s an explanation of an often misunderstood health insurance term and what it means.

OUT OF POCKET EXPENSES  are health care costs that you pay for yourself.

HOW OUT OF POCKET EXPENSES WORK
Some examples of out of pocket expenses are copayments, deductibles and coinsurance.

A COPAYMENT, or copay, is a set amount you pay when receiving care. You may be asked to pay a copay when you arrive for a doctor’s appointment, for example.

A DEDUCTIBLE is a set amount you must pay during the year before your insurance company begins to share costs with you. Once you have paid the full amount of your deductible, your insurance company may start paying for a portion of the remaining balance of your medical bills. If your plan has a 20 percent COINSURANCE, you would pay 20 percent of the remaining balance, and your insurance company would pay the rest of the bill.

Please call the phone number on the back of your ID card if you have any questions.

Ryan Schuster is an editor in the Communications department at Blue Cross Blue Shield of North Dakota.