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Estimate Medical Costs

Couple discusses cost of medical bills with doctor.You can’t always plan ahead for how you’ll pay health care bills (all the more reason to start an emergency savings fund), but what about the times when you can research medical costs beforehand? Where do you begin?

Know Your Max

If you have insurance, you should have received a statement of benefits explaining your coverage when you first signed up. (For example, when you started your job.) You can ask your employer’s human resources department for help accessing this information or set up an online account with the insurance company to download another copy of your policy.

Look for these key parts of your health insurance:

  • Deductible – How much you pay before insurance kicks in. For example, a $5,000 deductible means you’ll have to pay for $5,000 of treatments and services before your insurance pays according to your policy.
  • Copays and Co-insurance — Copays are a set amount, such as $30 per doctor visit. Co-insurance means you pay a percentage of the total. For example, if your policy is split 80/20 with your insurance company, then after the deductible is met, insurance pays 80 percent and you pay 20 percent of costs.
  • Out-of-pocket maximum — The most you will have to pay in a calendar year for qualifying expenses. Even if your medical costs reach more than $100,000, you won’t have to pay more than the yearly maximum according to the policy. But that only applies to tests, labs, treatments, procedures and medications that are covered by your insurance.
  • What’s covered — If you’ve been diagnosed with a specific condition or chronic illness, check your policy or call the insurer to clarify what is and isn’t covered.

If you don’t like what you find in your policy, consider changing your insurance coverage during the next open-enrollment period at your work or through the Affordable Care Act Marketplace. With insurance, the out-of-pocket maximum is a cap to how much you’ll be held responsible for. You can get preauthorized for planned procedures such as childbirth or outpatient treatments by calling your insurance company ahead of time to clarify costs.

Without insurance, there is no limit to how much you could owe. However, you can call the provider beforehand to ask for a discount and comparison shop to find the least expensive options. For example, some hospitals and urgent care facilities charge different fees for the same treatment.

Research Medical Costs

Woman researches health insurance pricing.Use free price comparison tools such as and to get ballpark estimates of medical costs, but prices vary widely depending on whether or not you need anesthesia, a hospital stay or follow-up medications.

Find more information about paying for prescription drugs at and get help with low-cost dental care at the U.S. Health and Human Services Department website. If you have very low or no income, then you likely qualify for Medicaid and your kids are eligible for the Children’s Health Insurance Program (CHIP).

When facing a long-term illness or chronic condition, use established support groups (online and in person) to connect with others who’ve been in your shoes. Often other patients and their families are the best source of up-to-date information about assistance programs, clinical trials and cutting-edge treatments.

Start with these links:

How Medical Debt Affects Your Finances

Unpaid medical debt shows up on your credit report after 180 days. Some credit reporting models don’t weigh medical debt as negatively as other debt when calculating your credit score.

When applying for a mortgage or car loan, late or missed payments on medical bills can lower your score. However, if you are making on-time payments on a medical bill, this could improve your credit. If you can’t afford your payments, call the health care provider to see about a new payment plan. Most creditors would rather get small on-time payments than nothing.

And if your medical bills are way too much for you to handle, it is worthwhile to investigate bankruptcy. Many people strain to pay huge debts when it would be more cost-efficient to file for bankruptcy early on. Consult with a reputable bankruptcy attorney and don’t agree to anything until you’ve had time to compare the pros and cons.

Tax Breaks for Health Care Costs

You can get a tax deduction for health care costs that exceed 10 percent of your adjusted gross income (AGI). But this only applies if you are itemizing deductions, which means for the 2019 tax year, you’ll need to come up with more than $12,200 in deductions if you’re single, more than $18,350 if you’re filing as head of household, and more than $24,400 if you’re married and filing jointly in order to make it more cost-efficient than using the standard deduction.

[Any reference to a specific company, commercial product, process or service does not constitute or imply an endorsement or recommendation by the National Endowment for Financial Education.]

Ver este artículo en espanol: Cómo calcular los gastos médicos