How much you pay for different services throughout the year can depend on what you’ve already spent in relation to your plan’s deductible and other key amounts. Here are some simple explanations for the amounts you typically need to know and how they work.
- Copay: These are the flat fees you pay each time you go to the doctor or fill a prescription. Copays do not count toward your deductible.
- Deductible: This is what you will pay per year for medical bills and prescriptions before your healthcare plan starts sharing the cost. Once you meet your deductible, your costs are determined by your plan’s coinsurance.
- Coinsurance: This is the set percentage of your medical expenses you will pay after you reach your deductible. You pay this percentage until you reach your plan’s out-of-pocket limit.
- Out-of-pocket limit: This is the limit for how much you will pay per year for services covered by your plan. Once you reach this limit, all covered services are paid by Medical Mutual at 100%.
Remember, only services that are covered by your health plan will count toward these amounts.
B – Browse your plan benefits
Before you have a service or procedure, be sure to review the benefits covered by your plan. There are two documents you can use to understand your benefits—your Summary of Benefits and Coverage (SBC) and your Medical Plan Description (MPD), which explain your plan’s costs, benefits, healthcare services and more.
C – Compare costs
Medical costs can vary based on several factors—like having the same test at a different location. Medical Mutual offers My Care Compare, an online tool to help you evaluate how different factors may affect costs for a wide range of medical services. It’s especially important when you need lab tests, which may be subject to your plan’s lab Coverage Maximum.
D – Don’t go out of network
Services performed by in-network healthcare providers usually cost significantly less than those that aren’t. In fact, some services may not be covered at all when you use a non-network provider. Always take the time to make sure your provider is in your network before you schedule a treatment or procedure.
E – Engage online
My Health Plan, Medical Mutual’s secure member website, helps you easily keep track of claims and deductible amounts. It's also where you can review your Explanation of Benefits (EOB) statements after you have services.
If you are a COSE MEWA member through Medical Mutual, creating your My Health Plan account is simple. Just visit MedMutual.com/Member and click Register for an Account. To learn more about other benefits offered through a COSE MEWA health plan, please contact your broker, Medical Mutual Sales representative or click here.