Patient Out-Of-Pocket Cost Estimate

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CMS Shoppable Services
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2 STEPS TO ESTIMATE THE COST

STEP 1 - CHOOSE YOUR COVERAGE
STEP 2 - CHOOSE YOUR SERVICE

2 STEPS TO ESTIMATE THE COST

STEP 1 - CHOOSE YOUR COVERAGE
STEP 2 - CHOOSE YOUR SERVICE
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  • Inpatient Room and Board Daily Charges
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  • Outpatient Pulmonary Therapy
  • Outpatient Respiratory Therapy
  • Outpatient X-Ray and Radiological
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Yearly Deductible

Your Yearly Deductible is the amount you must pay out-of-pocket for each benefit period (typically 12 months) before the insurance company will start paying. For example, if your deductible is $500, then you must pay the first $500 of your bills during the benefit period.

Deductible Already Paid

This is the Deductible amount you have already paid during the current benefit period. For example, if your deductible is $1,000 per benefit period and you had a medical service performed for $300, then you paid this full $300 medical service out-of-pocket, and you have $700 remaining on your deductible.

Co-Pay

A Co-Pay or Co-Payment is a fixed amount that you pay out-of-pocket each time you go to a hospital for a medical service. For example, if you have a S20.00 Co-Pay that means you owe this amount every time you have a medical service and this amount is separate from the amount you will be billed for your deductible and co-insurance.

Co-Insurance Percentage

This is the percentage amount that your insurance coverage pays after your deductible has been met. For example, if you have a $1,000 deductible and a 20% Co-Insurance, then for a $2,500 surgery bill, you would pay the first $1,000 as your deductible. The balance would be $1,500 ($2,500 less $1,000). Of the remaining $1,500, you would pay 20% per your Co-Insurance and your insurance company would pay the remaining 80% of the balance. In particular, your 20% Co-Insurance payment of the balance would be S300 (20% of $1,500) and the insurance company would pay $1,200 (80% of S1,500).

Out-of-Pocket Max Amount

This is the most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance, your health plan pays 100% of the costs of covered benefits.

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