This is not a cost estimator
These examples illustrate possible coverage scenarios and are not cost estimators. Your actual expenses will vary. Look at cost-sharing details like deductibles and coinsurance to compare coverage options. These examples assume self-only coverage.
Peg is Having a Baby
This example covers 9 months of in-network prenatal care and a hospital delivery.
The plan's overall deductible is $1,800. Specialist coinsurance is 20%, hospital (facility) coinsurance is 20%, and other coinsurance is 20%.
Services Included
Specialist office visits (prenatal care)
Childbirth and delivery professional services
Childbirth and delivery facility services
Diagnostic tests (ultrasounds and blood work)
Specialist visit (anesthesia)
Breakdown of Costs
Breakdown of Costs for Peg's Baby Delivery
Cost Category | Amount |
|---|---|
Deductibles (Medical and Rx) | $1,800 |
Copayments | $0 |
Coinsurance | $2,180 |
Limits or exclusions | $0 |
Total Peg would pay | $3,980 |
Joe’s Type 2 Diabetes Management
This example covers a year of routine, in-network care for a well-controlled type 2 diabetes condition.
The plan's overall deductible is $1,800. Specialist coinsurance is 20%, hospital (facility) coinsurance is 20%, and other coinsurance is 20%.
Services Included
Primary care provider office visits (including chronic condition education)
Diagnostic tests (blood work)
Prescription drugs
Durable medical equipment (glucose meter)
Breakdown of Costs
Cost Category | Amount |
|---|---|
Deductibles (Medical and Rx) | $75 |
Copayments | $194 |
Coinsurance | $200 |
Total Joe would pay | $469 |
Mia’s Simple Fracture
This example covers an in-network emergency room visit and follow-up care for a simple fracture.
The plan's overall deductible is $1,800. Specialist coinsurance is 20%, hospital (facility) coinsurance is 20%, and other coinsurance is 20%.
Services Included
Emergency room care (including medical supplies)
Diagnostic test (X-ray)
Durable medical equipment (crutches)
Rehabilitation services (physical therapy)
Breakdown of Costs
Cost Category | Amount |
|---|---|
Deductibles (Medical and Rx) | $1,800 |
Copayments | $50 |
Coinsurance | $190 |
Limits or exclusions | $0 |
Total Mia would pay | $2,040 |