Benefits

Plan costs: premiums and deductibles

To choose the plan that’s best for you and your family, you have to know how much it costs. One mistake people make is to focus only on the premium without also considering other costs, such as the deductible.

How you pay for health insurance

Each month you pay the premium, which is automatically deducted from your paycheck. You pay this even when you don’t visit the doctor or otherwise use any health care services.

When you do visit the doctor, what you pay goes toward your annual deductible. Once you pay the entire cost of the deductible, your insurance begins paying for part of your health care costs. The part you pay takes the form of either coinsurance or copayments.

With coinsurance, the costs you pay for services are calculated as a percentage (for example, 20 percent). Insurance pays the remaining percentage of the cost. With copayments, on the other hand, you pay a fixed amount (for example, $20).

Generally, you’ll pay coinsurance after your visit the doctor, when the bill arrives in the mail. Copayments are usually made at the doctor’s office, when you get the service.

While plans using coinsurance are more common, some people prefer plans with copayments because costs are more predictable.

Once you begin paying coinsurance or copayments, the most you’ll have to pay during a year for covered services is the out-of-pocket limit. Most people don’t reach their out-of-pocket limit during a typical, healthy year. Both the out-of-pocket limit and the deductible reset at the beginning of each year.

Compare plan costs

When comparing plans, make sure to consider both the premium and the deductible — the tables below summarize those costs. For full details about the cost of a plan, including coinsurance and copayments for specific medical services and prescriptions, use the PEBB medical benefit comparison tool and review the plan coverage documents.

Employee-only costs
Plan Premium (per month) Deductible (per year) Out-of-pocket limit (per year)
Group Health CDHP $22 $1,400 $5,100
Group Health Classic $118 $250 $2,000
Group Health SoundChoice $45 $250 $3,000
Group Health Value $81 $350 $2,000
Kaiser Permanente CDHP $29 $1,400 $5,100
Kaiser Permanente Classic $144 $300 $2,000
UMP Plus: Puget Sound High Value Network $59 $125 $2,000
UMP Plus: UW Medicine Accountable Care Network $59 $125 $2,000
UMP CDHP $21 $1,400 $4,200
UMP Classic $84 $250 $2,000
Employee and family costs
Plan Premium (per month) Deductible (per year) Out-of-pocket limit (per year)
You and spouse or partner You and child(ren) Full family
Group Health CDHP $54 $39 $71 $2,800 $10,200
Group Health Classic $246 $207 $335 $750 $4,000
Group Health SoundChoice $100 $79 $134 $750 $6,000
Group Health Value $172 $142 $233 $1,050 $4,000
Kaiser Permanente CDHP $68 $51 $90 $2,800 $10,200
Kaiser Permanente Classic $298 $252 $406 $900 $4,000
UMP Plus: Puget Sound High Value Network $128 $103 $172 $375 $4,000
UMP Plus: UW Medicine Accountable Care Network $128 $103 $172 $375 $4,000
UMP CDHP $52 $37 $68 $2,800 $8,400
UMP Classic $178 $147 $241 $750 $4,000