Health Insurance Vocabulary!
Health insurance is a complex and often confusing topic for many people. Understanding the vocabulary of health insurance is crucial to making important decisions about your coverage. In this blog post, we will explain some of the most common health insurance vocabulary words.
Deductible: A deductible is the amount of money you pay out of pocket before your insurance kicks in. (For example, if you have a $1,000 deductible, you would need to pay the first $1,000 of your medical expenses before your insurance begins to cover costs.)
Copayment: A copayment, or copay, is a fixed amount you pay as an entry fee for a specific medical service or prescription. (For example, if your copay for a doctor’s visit is $20, you would pay $20 at the time of the appointment.)
Coinsurance: Coinsurance is the percentage of medical expenses you are responsible for paying after you have met your deductible. (For example, if you have a 20% coinsurance, you would be responsible for paying 20% of the total cost of your medical expenses, and your insurance would cover the remaining 80%.)
Premium: A premium is the amount you pay each month for your health insurance coverage.
Out-of-pocket maximum: The out-of-pocket maximum is the maximum amount of money you will have to pay for covered medical expenses in a given year. Once you reach this amount, your insurance will cover all remaining costs.
Network: A network is a group of healthcare providers and facilities that have contracted with an insurance company to provide services to their members. In-network providers typically offer lower costs to insured individuals.
Provider: A provider is a healthcare professional or facility that provides medical services. This can include doctors, hospitals, clinics, and pharmacies.
Pre-existing condition: A pre-existing condition is a health condition that existed before you enrolled in your current health insurance plan. In the past, insurance companies could deny coverage or charge higher premiums to people with pre-existing conditions, but this is no longer allowed under the Affordable Care Act.
HMO, PPO, and EPO: These are types of health insurance plans that differ in terms of the flexibility they offer. HMOs, or health maintenance organizations, require you to choose a primary care physician and typically only cover care within their network. PPOs, or preferred provider organizations, allow you to see out-of-network providers but often at a higher cost. EPOs, or exclusive provider organizations, are similar to HMOs but may offer some out-of-network coverage in certain circumstances.
Understanding these health insurance vocabulary words can help you make more informed decisions about your healthcare coverage. When shopping for health insurance or discussing coverage with your provider, be sure to ask questions and clarify any terms you don't understand.
