Health care costs today can be complicated. It’s not always easy to understand why sometimes you pay nothing when you visit a health care provider and other times you are asked to pay quite a bit. It all depends on the details of your health plan.
While health plans are not all the same, there are some basics that will help you understand when you’ll be charged for a visit, test, or procedure, and what you’ll need to pay.
Health care costs definitions
First, let’s define a few terms:
- Premium: The amount you pay monthly for your plan.
- Deductible: The amount you pay for covered services each year before your plan starts paying.
- Copay: A fixed amount you pay for a covered service such as an office visit.
- Coinsurance: A percentage of the charges that you pay for a covered service, usually 20% or 30%. For example: If a procedure is $200 and your coinsurance is 20%, you pay just $40. Kaiser Permanente covers the rest ($160).
- Out-of-pocket maximums: The most you’ll pay for covered services each year. Your deductible, copays, and coinsurance all count toward this amount. Once you reach this amount, you generally won’t have to pay for covered services the rest of the year. You will, however, need to continue to pay your premiums.
Tip: If you’re a current Kaiser Permanente member, sign in to your online account at kp.org/wa to see your medical expenses for 2019. While you can’t plan for every medical need, consider what you do have planned or might expect for the coming year. Will you need more or less coverage than previous years?
Plan benefits included at no additional cost
If you’re a current Kaiser Permanente member, your health plan offers a variety of ways to get medical care at no extra cost to you.
- An annual preventive visit is covered at 100%; however, if your preventive visit includes a diagnosis or treatment for a specific health concern, you may get a bill for the copay or coinsurance of the non-preventive services if you have not yet met your deductible. Check your Evidence of Coverage by logging in to kp.org/wa or call Member Services for details specific to your plan.
- Through Care Chat, an online messaging service, you can receive real-time medical care from a Kaiser Permanente provider. This service is available 7 days a week, 24 hours a day.
- Whenever you have a health concern, you can talk with a nurse over the phone 24/7, 365 days a year. The consulting nurse will listen to your concern and offer you advice or will direct you to the best location to get care. Call the consulting nurse at 206-630-2244 or 1-800-297-6877.
Open enrollment reminders
- Individual and family plan open enrollment starts November 1, and the enrollment deadline is December 15 for coverage starting January 1.
- Medicare Advantage annual enrollment period began October 15, and the deadline to enroll is December 7.
- School Education Benefits Board (SEBB) open enrollment began October 1 and ends November 15.
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