Navigating health insurance can sometimes feel like learning a new language. If you’ve ever found the terms confusing, you’re not alone—and we’re here to help. Below, we explain the most commonly used health insurance terms and answer some frequently asked questions.
Key Health Insurance Terms:
- Premium: The amount you pay regularly (monthly, quarterly, etc.) for your health insurance plan.
- Co-payment (Copay): A fixed amount you pay for a covered healthcare service, usually at the time of service (e.g., $20 for a doctor’s visit).
- Deductible: The amount you pay out of pocket for covered services before your insurance begins to pay.
- Out-of-Pocket Maximum/Limit: The maximum amount you’ll pay in a year for covered services, including deductibles, copays, and co-insurance. After this limit is reached, your insurance covers 100% of covered services.
- Co-insurance: Your share of the costs of a covered service, expressed as a percentage (e.g., 20%), after you’ve met your deductible.
- In-Network: Providers and facilities that have contracts with your health insurance plan to provide services at negotiated rates.
- Covered Services: Medical services and treatments that your insurance plan agrees to pay for.
- Excluded Services: Medical services and treatments not covered by your insurance plan. You’ll pay the full cost for these services.
- Open Enrollment Period: The annual time frame when you can enroll in or change health insurance plans.
- Special Enrollment Period: A time outside the open enrollment period when you can enroll in health insurance due to a qualifying life event (e.g., marriage, birth of a child).
- Subsidy: Financial assistance provided by the government to help lower the cost of health insurance premiums for eligible individuals and families.
- Tax Credit: A type of subsidy that reduces the amount you owe on your taxes, often used to lower monthly premium costs.
- Health Insurance Marketplace: A platform where individuals and families can shop for and compare health insurance plans.
- Essential Health Benefits: A set of healthcare services that must be covered by health insurance plans, such as emergency care, maternity care, and prescription drugs.
- Short-Term Health Plan: Temporary insurance designed to provide coverage for a limited period, often used as a stopgap.
- Schedule of Benefits: A detailed list of what your health insurance plan covers, including costs and limitations.
