Patients may not be informed of this upfront; ask the question if it is a concern.
There are two basic types of plans.
Traditional plans, which often have low copayments for regular visits, and High Deductible health plans.
Traditional plans are what many people used before healthcare reform. They had copayments
(a small amount due at the time of service) for regular Dr. visits and medications. They have
a deductible and coinsurance for unusual things like MRI’s, CT Scans, and hospital visits.
These plans tend to be more expensive every month, but generally require a smaller portion
to be paid by you when a claim happens.
High Deductible health plans are paired with a tax-protected savings account called a Health
Savings Account or HSA. These plans require that your deductible come first unless it is a
preventive service.
To download the complete guide, click here.
This post was updated on 12/1/2025
Below is the table that the federal government uses to determine health insurance assistance.
If your income falls between 135% and 400% of the federal poverty level for your family size you may qualify for assistance with your premiums.
Note: Each individual program–e.g., SNAP, Medicaid–determines how to round various multiples of the poverty guidelines, what income is to be included, and how the eligibility unit is defined. For more information about the poverty guidelines visit:
https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines
Source: U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation.
According to a recently published healthcare economics paper, different insurers pay varied prices for the same services and procedures at the same hospital, indicating that bargaining leverage really does impact healthcare prices.
Authors took actual data from claims for three national insurers. Studies showed that dominate hospitals can dictate how much they are going to get paid for specific services and procedures. For hospitals that hold an monopoly in their area, that number was 12.5% higher than those who had nearby competitors. For more concentrated markets, providers can shift more risk to insurers, which affects the ability to keep prices at a set standard.
“Researchers also found that prices increased by more than 6% when merging hospitals were less than 5 miles apart. They didn’t find significant price impact when the hospitals were separated by at least 25 miles.”
Sources: The Price Ain’t Right? Hospital Prices and Health Spending on the Privately Insured Zack Cooper (Yale University) Stuart V. Craig (University of Pennsylvania) Martin Gaynor (Carnegie Mellon University and NBER) John Van Reenen (Massachusetts Institute of Technology, CEP, and NBER)
Modernhealthcare.com
Health Care Cost Institute
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