Understanding your health care costs, simplified

Helping MyPriority members make informed decisions about care.

Page last updated on: 4/29/26

Health care should be straightforward and easy to understand

When you have a MyPriority® Individual and Family plan, you deserve clear information about what impacts your costs, and access to tools that help you plan confidently.

At Priority Health, our goal is simple: the cost of your care shouldn’t come as a surprise. Understanding what drives health care costs can help reduce uncertainty and make it easier to plan.

By the end of this page, you’ll understand what impacts your health care costs, why prices vary and how to use MyPriority tools to plan ahead with confidence.

Understanding the cost equation

Many factors influence what you pay for health care, and no single factor determines the final cost. That’s why we focus on transparency – so you can better understand what drives costs and how your choices may affect what you pay.

Here are the key factors that shape your expenses:

  • Where and how you receive care
    Getting care in the emergency room usually costs more than visiting an urgent care center or using virtual care. Choosing the right setting for non-emergency needs can help manage costs.
  • Your plan design
    Plan design matters because features like copays, deductibles, coinsurance and network rules all influence what you pay when you get care.
  • Chronic conditions and care use
    Ongoing health conditions and how often you need care – such as regular doctor visits, tests or treatments – can affect both your out‑of‑pocket costs and overall plan spending.
  • Hospital and provider prices
    Hospitals, doctors and clinics set their own prices, which means the same service can cost different amounts depending on the provider and location.
  • Prescription drug costs
    The type of medication you take, whether a generic or brand-name option is used, and how often prescriptions are filled all play a role in total costs.
  • Administrative and regulatory requirements
    State and federal rules help make sure health plans provide reliable, comprehensive coverage, which can influence how benefits are designed and priced.
Together, these factors help explain why health care costs can vary, sometimes significantly, even for the same service, depending on the situation, provider and location.

How to plan for costs with a MyPriority plan

Understanding how health care costs work helps MyPriority members make informed decisions before getting care – not after a bill arrives – when choices and settings still matter. While no estimate can account for every possible variable, planning ahead helps reduce uncertainty and avoid unexpected surprises. 

With a MyPriority plan, members can:

This information helps members make decisions based on cost, convenience, and care needs – not guesswork.

Plan ahead with MyPriority tools

MyPriority plans put you in control with intuitive tools designed to help you understand expected costs, plan ahead and make more confident care decisions.

Before getting care

For ongoing care

  • Track spending and benefits through your member account
  • Review plan details to understand what impacts your out‑of‑pocket costs

For prescriptions

  • Use PriceMyMeds to estimate medication costs and review alternatives
  • Use an in-network pharmacy so, if discounts are available, you automatically receive lower prices

These tools help members understand costs in advance so they can plan ahead and make more confident decisions.

Because health care needs can change, estimates reflect the information available at the time, making it even more important to compare options and plan ahead.

Logging into your member account before you schedule care can help you understand costs early, when choices still matter.

Even with good information, common assumptions about health care costs can cause confusion. Let’s clear up a few of the most common ones.

Myths vs. facts: What really affects health care costs

Health care pricing isn’t driven by a single factor. Understanding what does influence costs can help explain why prices vary and how planning ahead can help.

Fact: Where you receive care matters.

Emergency rooms are designed for serious, life‑threatening situations and typically cost more than urgent care or virtual visits, which may be appropriate for many non‑emergency needs.

With many MyPriority plans, virtual care often costs $0–$10, while in‑person urgent care visits typically have higher copays. The exact amount depends on your plan and whether your deductible applies.

Copays and costs vary by plan and provider. Members should check their plan details or use Cost Estimator for exact costs.

 

Fact: Chronic conditions can affect health care costs over time.

Conditions like asthma, diabetes or high blood pressure often require regular doctor visits, tests, treatments or prescriptions, which can influence both out‑of‑pocket costs and overall plan spending.

How often care is needed – and the type of care required – can make a difference in what members pay throughout the year.

Many MyPriority plans provide access to covered medical services, supplies and medications for chronic conditions with a copay or coinsurance, even before the deductible is met.

Fact: Prescription drug costs depend on several factors.

The cost of prescription drugs can vary based on the medication prescribed, whether a generic option is available, and how often prescriptions are filled.

Some medications may be covered with a fixed copay, while others may apply toward a deductible or have different cost‑sharing rules.

Members should review their prescription benefits or drug list to understand coverage and costs. MyPriority plan members can also use PriceMyMeds, which searches for, applies discounts and alerts you so that you pay a lower prescription price if one is available.

Fact: Hospitals and providers set different prices.

Doctors, hospitals and clinics negotiate their own prices, which is why the same service can cost more at one location than another.

Using in‑network providers generally costs less than going out-of-network, but prices can still vary within the network.

Members can use plan tools or resources to help compare costs before getting care.

Fact: The ER isn’t always the fastest – or most affordable – way to get care.

Emergency rooms prioritize life‑threatening conditions, which can mean longer wait times and higher costs for non‑emergency needs.

For many common illnesses or minor injuries, urgent care or virtual visits can offer quicker access to care and usually cost less than an ER visit.

Choosing the right type of care for your situation can help manage both wait times and out‑of‑pocket costs.

Fact: Rules and requirements influence how plans work.

State and federal regulations help make sure health plans provide reliable, comprehensive coverage and meet required standards.

These requirements can affect how benefits are structured and how costs are shared between members and the plan.

Plan documents provide the most accurate details about coverage and cost‑sharing.

Fact: Preventive care is often covered at no cost when guidelines are met. 

Preventive care focuses on keeping you healthy – like routine checkups, screenings and immunizations – and many of these services are covered at no cost when received as recommended.

However, sometimes a preventive visit leads to more specific care. If you discuss new symptoms, your provider orders additional tests, or a condition is evaluated, monitored or treated, all or part of the visit may be considered diagnostic. Diagnostic care is typically subject to your plan’s normal cost‑sharing, such as copays, deductibles or coinsurance.

Using Cost Estimator before your visit can help you understand how preventive and diagnostic services may be covered, what costs to expect and how different care options compare. Reviewing estimates in advance gives you clearer expectations and helps you make more confident decisions about your care.

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Hidden costs of going uninsured

Cost information is based on current plan details and available estimates. Because health care needs and coverage can change, members should always review plan materials for the most up‑to‑date information.