I’m paying for health insurance every month. Why am I still getting medical bills?

The short answer is simple: Health insurance is a cost-sharing program. You and your insurance company both pay for your health care.

Here’s what the common insurance terms mean:

  • Premium: The amount you pay each month to keep your health insurance coverage.

  • Deductible: The amount you pay for covered health care before your insurance begins paying for many services.

  • Copay: A fixed dollar amount you pay for a covered service, such as an office visit or prescription.

  • Coinsurance: Your share of the cost of a covered service after you’ve met your deductible. It’s usually a percentage of the cost.

  • Out-of-pocket maximum: The most you’ll pay for covered health care during your plan year. Once you reach this limit, your insurance generally pays 100% of covered services for the rest of the plan year.

Even if you have health insurance, you may still receive a medical bill because part of the cost is your responsibility under your plan.

The bottom line: Health insurance isn’t designed to pay all of your medical bills. It’s designed to help pay them while protecting you from catastrophic medical expenses.

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