Learn the basics
Short, plain answers to the questions people ask most about medical prices.
What is a cash price?
The price a hospital or provider charges people who pay for themselves instead of using insurance. It is often much lower than the full price, and sometimes lower than what an insurance plan pays.
If you have a high deductible, paying the cash price can cost less than going through insurance. Ask whether a cash payment counts toward your deductible.
What is the "full price"?
Also called the "gross charge" or "chargemaster" price: the full price before any discount. Very few people pay it. Insurance plans and cash-paying patients usually pay less.
What is my plan's rate, and what will I owe?
Your insurance company agrees on a rate with each hospital. That rate is the total bill for your care. What you pay depends on your plan: your deductible (what you pay before insurance starts paying), then coinsurance (a percentage) or a copay (a set amount), up to your out-of-pocket maximum.
Call the number on your insurance card for an estimate of your share.
Why might I get more than one bill?
The hospital or surgery center bills for the room, equipment and staff (the "facility fee"). Doctors, the anesthesia team, radiologists and labs often bill separately. Our whole-procedure estimates show which pieces have published prices and which don't.
What is a Good Faith Estimate?
If you don't have insurance or won't use it, providers must give you a written estimate of expected charges when you schedule care at least 3 business days ahead, or when you ask. If the bill is at least $400 more than the estimate, you can dispute it within 120 days. Learn more at cms.gov/nosurprises.
How does hospital financial assistance work?
Nonprofit hospitals must have a written financial assistance policy, and many other hospitals offer one. Most give free care below one income level and discounts up to a higher level, based on household size. Many people with insurance qualify too.
You can usually apply before or after your care, often for months after the first bill. Ask for the application and have proof of income ready.
Am I protected from surprise bills?
The federal No Surprises Act protects most people with insurance from surprise out-of-network bills for emergency care and for some care at in-network hospitals and surgery centers. If you think a bill breaks these rules, contact the No Surprises Help Desk at 1-800-985-3059.