My family's monthly premium is $1,004.38, or $502.19 per paycheck.

TIP: Your employer can write their portion off their taxes. You cannot, unless you buy health insurance privately.

4) You now have access to two kinds of doctors: in-network (those who have a contract with your health insurance company) and out-of-network (those who do not have a contract, or are not preferred doctors.) TIP: Many (most) doctors/medical practices will refuse to see a patient who does not have insurance. Another, smaller, subset will refuse to see someone with government-sponsored health insurance (i.e., Medicaid).

5) You get sick. You go to the doctor. If your doctor is in-network, they have agreed to see you and will bill you the negotiated price. If the doctor is out-of-network, they may choose to accept the negotiated price or not. Your insurer, because they did not have a contract with this health care provider, typically requires you to pay a significantly higher amount negotiated amount--if they pay anything at all. If the insurance doesn't pay anything, you must pay the fees out of pocket. When you arrive, you have to pay the co-pay, which is a standard set fee due at the time of service. The exact fee depends on your insurer, but in my experience, it ranges from $20-$50 per visit, per person, per doctor. 6) After the visit, usually within a month, you will get a bill. The bill will usually have the doctor's standard price. Then it will also have the negotiated price. Your health insurance company will also send you a copy of the bill the provider sent to them, and tell you what the health insurance company has decided to pay. TIP: In many US states, the doctor can bill you for the difference between the standard price and the negotiated price. This is called balance billing. Luckily, balance billing is illegal in my state. Your insurance will usually have a deductible, which is an amount you pay before the insurance company pays any of the negotiated price. My insurance plan has a $3,000 per person deductible, which means that I must pay $3,000 over the course of a year for a single person on the plan before the insurance company pays any part of the negotiated bills. My family deductible is $6,000 per year. Your insurance may have co-insurance, which means that you must pay a percentage of the negotiated price.

In my case, I pay 20% of the negotiated price, which counts toward the deductible. After the deductible is met, I am still responsible for 20% of the bill, until the out-of-pocket maximum is met.

7) Your doctor may prescribe a medication. The insurance company usually has a preferred formulary, or a medication list that they will require you to try before a non-preferred drug. Some medications will not be covered at all, but that is rare. When you go to the pharmacy, your medication will also have a standard co-pay, which varies depending on the medication. An older, generic medication on the formulary might cost $$ a month. My insurance has a $10 monthly copay for an older, generic medication, a $30 monthly copay for more expensive medications on the preferred formulary list, and a $60 monthly copay for nonpreferred medications. Specialty medications are not covered. 8) The out-of-pocket maximum is a legal requirement. That is the yearly total amount that I will pay for visits (including co-insurance), co-pays, and medication. After that, the insurance company pays for everything. My family out-of-pocket maximum $14,000. 9) You may have access to a Health Savings Account (HSA) or Flexible Spending Account (FSA). You can direct a portion of your pre-tax income to one or both of these. The 2026 annual maximum HSA deposit is $8,750 per account. An HSA will roll-over from year to year, meaning that what you don't spend will be available to you next year. An FSA doesn't roll over, which means that you lose any month left in the account at the end of the year.