If you found yourself frequently visiting the doctor recently, or have been frequently using your health insurance, you may have wondered if extensive use of your health insurance will increase your premium. The only factors that usually affect your health insurance premiums are: body mass index, age, gender, family history, tobacco use, marital status, pre-existing medical conditions, profession, zip code, and whether or not you were previously insured.
Most health insurance plans have the same components, which include: deductible, co-insurance, co-payments, out-of-pocket, and lifetime maximum.
Deductible – Your deductible is the amount of money that must be paid to the insurer before the benefits of the health plan can be utilized. This amount is typically a yearly amount, so each year the deductible resets. Usually, services such as doctor visits are able to be used prior to meeting the amount of deductible.
Co-insurance – Co-insurance is the insured’s share of the cost of the plan and is usually a percentage share such as 80/20. This would mean that the insured would be responsible for 20% and the plan would pay 80% for health services rendered.
Co-payments – Co-payments are typically a fixed amount of money that the insured must pay at the time of service. For example, co-payments are required for prescription drug purchases and doctor visits.
Out-of-Pocket – Out-of-pocket is exactly what it sounds like – the amount that an insured is expected to pay out of their own pocket. The out-of-pocket amount includes money paid for co-payments, co-insurance, and deductibles. Out-of-pocket is typically referred to when referring to an insured’s annual out-of-pocket maximum. The annual out-of-pocket maximum is the maximum amount that an insured would have to pay in one calendar year. If the amount of the co-payments, co-insurance, and deductibles (not including premiums) that an insured has paid in one year meet or exceed the annual out-of-pocket maximum of the plan, then the insured does not owe the insurer any more money for rest of the year, regardless of what or how many services are used after that. This amount is subject to a lifetime maximum as described below.
Lifetime Maximum – The lifetime maximum is the maximum amount of money that the health plan will pay for an insured’s medical expenses for the entire life of the insured.
To address the title question: No, extensive use of a health insurance plan generally does not increase the premium, but the dollar amount of the coverage you are provided in a lifetime cannot exceed the plan’s lifetime maximum per individual and/or per family.