Health Insurance: Networks, Deductibles, and What a Bill Looks Like
Aligned to JS:RM-4 — Jump$tart National Standards in K-12 Personal Finance Education & Advance CTE Career Clusters.
What this lesson teaches
Health coverage has four numbers that interact: the premium you pay monthly, the deductible you pay before coverage starts, the copay or coinsurance you pay per visit, and the out-of-pocket maximum that caps your worst year. Whether a provider is in your network changes all of them.
Worked examples
Example 1
A plan with a $250 premium and $1,500 deductible costs $3,000 a year even if you never go. A plan with a $90 premium and $7,000 deductible costs $1,080 — until something happens.
Example 2
An in-network MRI might cost you $400 against your deductible; the same scan out of network can be billed at full price with little or none of it counting.
Example 3
The out-of-pocket maximum is the number that matters in a catastrophe. It is the answer to 'what is the worst this year can cost me.'
Practice questions
- Define premium, deductible, copay and out-of-pocket maximum.
- Compare the two plans above for someone with no medical costs, and for someone with $20,000 in costs.
- Why check whether a doctor is in network before the appointment?
Watch the lesson
Every lesson comes with a video taught in English and Spanish — the same video the QR code in the printed workbook opens.
▶ Watch this lessonEn español
Seguro médico: redes, deducibles y cómo se ve una cuenta
La cobertura médica tiene cuatro números que interactúan: la prima que pagas al mes, el deducible que pagas antes de que empiece la cobertura, el copago o coaseguro por visita, y el máximo de gastos de bolsillo que limita tu peor año. Que un proveedor esté dentro de tu red cambia todos ellos.
Ejemplo 1: Un plan con prima de $250 y deducible de $1,500 cuesta $3,000 al año aunque nunca vayas. Un plan con prima de $90 y deducible de $7,000 cuesta $1,080 — hasta que pasa algo.
Ejemplo 2: Una resonancia dentro de la red podría costarte $400 aplicados a tu deducible; la misma prueba fuera de la red puede cobrarse a precio completo y casi nada cuenta.
Ejemplo 3: El máximo de gastos de bolsillo es el número que importa en una catástrofe. Es la respuesta a '¿cuánto es lo peor que me puede costar este año?'
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