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Annual deductibles have increased 53% since 2013 — and grown 8 times faster than wages since 2008.1
Patients today are taking on more responsibility for their overall healthcare costs, and many are feeling the impact of rising premiums and deductibles. Since these are often the first healthcare expenses you pay, it’s important to understand what these terms mean— and how they can impact your budget.
Premium: What you pay each month for your health insurance plan.
When you have health insurance, you pay a premium or fee to be enrolled in the plan. This payment is in addition to your plan’s deductible and copay or coinsurance.
Deductible: How much you have to pay out-of-pocket before insurance pays.
Your deductible is the amount of money you must pay for healthcare before your insurance will begin paying for covered expenses. Deductibles don’t include the money you pay for copays or coinsurance required by your plan. Deductibles reset once a year, which means you’ll have to meet it again each year you’re enrolled before insurance coverage kicks in for that year.
Out-of-pocket maximum: The most you have to pay for covered services in a plan year.
This is the most you can be expected to spend on your deductible, copays and/or coinsurance. Once you’ve reached this amount, your health insurance plan pays 100% of the cost of covered benefits. This limit doesn't include your monthly premiums or any amounts you pay for services not covered by your plan.
In 2019 both the maximum deductible and out-of-pocket limit for ACA Marketplace plans are $7,900 for an individual and $15,800 for a family.2
How do premiums and deductibles work? Think of it like this:
- You need knee surgery that will cost $10,000.
- You have health insurance with a $300 monthly premium, which doesn’t apply to your knee surgery cost.
- In addition to your premium, you have a $3,000 deductible that you’ll have to pay before your insurance will cover some or all of the remaining $7,000. This amount, or percentage, can vary according to your specific plan.
Out-of-pocket healthcare costs and your budget.
Rising premiums and deductibles can make it challenging to fit healthcare expenses for you and your family into your budget. As you look for ways to manage the cost, you may find that payment options can help you budget for your out-of-pocket deductible, copays and coinsurance expenses. This can help you prepare with a way to pay each time you visit your healthcare provider.
CareCredit: A convenient option to help manage healthcare costs.
With the CareCredit credit card, you and your family can get the care you want and need, without having to delay treatment due to the cost of care. Plus, CareCredit's special financing options give you a way to pay over time with convenient monthly payments.*
In the example above, you could use your CareCredit card to finance the $3,000 out-of-pocket costs (your deductible) to reach your deductible, and then make monthly payments that help fit the cost of care into your budget.*
The CareCredit credit card is accepted at more than 210,000 healthcare provider and health-focused retailer locations nationwide. Learn more about the many ways the CareCredit card makes it easy to access care without delay.
*Subject to credit approval. Minimum monthly payments required. See carecredit.com for details.
1“2018 Employer Health Benefits Survey,” Henry J. Kaiser Family Foundation, published Oct. 3, 2018 https://www.kff.org/health-costs/report/2018-employer-health-benefits-survey/, accessed Dec. 4, 2018
2“HHS Notice of Benefit and Payment Parameters for 2019,” Health and Human Services Department, April 17, 2018 https://www.federalregister.gov/documents/2018/04/17/2018-07355/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2019, accessed Dec. 4, 2018
This content is subject to change without notice and offered for informational use only. You are urged to consult with your individual business, financial, legal, tax and/or other advisors [and/or medical providers] with respect to any information presented. CareCredit, Synchrony and any of its affiliates (collectively, “Synchrony”) make no representations or warranties regarding this content and accept no liability for any loss or harm arising from the use of the information provided. Your receipt of this material constitutes your acceptance of these terms and conditions.