A premium is the monthly cost of having a plan. You pay it whether or not you see a doctor, and it is separate from the deductible, copays and coinsurance you pay when you use care.
In New York this is where the programs split most visibly:
| Coverage | Monthly premium |
|---|---|
| Medicaid | $0 |
| Essential Plan | $0 |
| Child Health Plus | $0 to a small amount, by family income |
| Marketplace plan | varies, reduced by tax credits applied in advance |
The trap in comparing plans by premium. The cheapest premium usually carries the highest deductible, so the plan costs least for someone who never uses it and most for someone who does. If you take regular medication or see a specialist, compare the total: premium times twelve, plus the deductible, plus expected copays.
Premiums do not count toward the out-of-pocket maximum. That ceiling covers what you pay for care, not what you pay for the card.
Also called: monthly premium. Reference: Premium on Wikipedia — general definition, not New York specifics.
More in Glossary of health coverage and billing terms
- Good faith estimate — A written cost estimate uninsured and self-pay patients are entitled to before scheduled care.
- Balance billing — When a provider bills you for the gap between its charge and what your plan paid.
- Federal poverty level (FPL) — A federal income benchmark, updated each January, that decides eligibility for most health programs in New York.
This page explains how the system works. It is not medical advice. More.