Understanding Health Insurance Terms

Top FAQs for Understanding Health Insurance Terms

How to understand your costs and key health insurance terms | HealthCare.gov

Know what services your plan will pay for and how much each visit or medicine will cost

Insurance plans can differ in which providers you can see and how much you have to pay. It’s important to understand your costs and key health insurance terms, so you’ll know what services your plan will pay for and how much each visit or medicine will cost.

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Understanding Health Insurance Basics: 10 Common …

Coverage. Whether or not your health insurance plan will contribute to specific services or …Deductible. A deductible is what you, the insured, need to pay for medical services before …Premium. A premium is an amount you pay every month to have a health insurance plan in …Co-pay. A co-pay, sometimes called a copayment, is a fixed cost for a specific service that …Coinsurance. Coinsurance is the portion of the medical cost that you, the insured, are …Out-of-pocket maximum. The absolute most you, the insured, can pay for covered medical …HMO. A Health Maintenance Organization (HMO) is a type of health insurance plan. It …PPO. A Preferred Provider Organization (PPO) is a type of health insurance plan. PPO …Outpatient care. Outpatient care is the health care you get when not admitted or staying at a …Inpatient care. Inpatient care is the health care you get when admitted to a health care …

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Quick Guide: Understanding Health Insurance Terms - ThinkHealth

Understanding health insurance terms is crucial when selecting a health insurance plan for you and your family. Learn more.

Understanding health insurance terminology is essential when shopping for a new plan or renewing your current plan. Here are just a few terms that are important to master before you make any health care decisions.

Deductible – This is the amount you pay out-of-pocket for covered health care services before your health insurance provider begins to pay. It may take a few doctor’s visits before you meet your deductible.

Copayment – A fixed amount you pay for a covered health care service each time you receive it. The amount can vary depending on the type of service. You often may hear this referred to as a co-pay.

Coinsurance – Sometimes the cost for your medical services is shared between you and the health insurance company. Coinsurance is calculated as a percentage of the total cost you must pay above and beyond your copay. For example, you may be responsible for 20 percent of the cost, while the insurer covers the remaining 80 percent.

Provider network – A network of providers who are contracted to provide health care services to plan members. An in-network visit is often less expensive as the health insurance company and the provider have negotiated lower rates.

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CDC: Most adults don't understand health insurance needs

2:00 - 3 years ago

Local health insurance provider Managed Health Services gets several calls with questions about basic terms.

Your guide to understanding health insurance policies

Category: Health Insurance Coverage

Our guide will help you understand the basics of health insurance, how to read your policy and understand your type of coverage.

Ashlee, a former managing editor, insurance, at QuinStreet, is a journalist and business professional. She earned an MBA in 2014 with a concentration in finance. She has more than 15 years of hands-on experience in the finance industry. Read full bio >>

At Insure.com, we are committed to providing honest and reliable information so that you can make the best financial decisions for you and your family. All of our content is written and reviewed by industry professionals and insurance experts. We maintain strict editorial independence from insurance companies to maintain our editorial integrity, so our recommendations are unbiased and are based on a comprehensive list of criteria.

Health insurance policies are legally binding contacts, which can have a major impact on both your health and financial life, so understanding your coverage is extremely important. Waiting until you are seriously ill or involved in an accident to investigate your health plan is major mistake.

Our guide will help you understand the basics of health insurance, how to read your policy, understand your type of coverage and how to make changes to you plan, if necessary.

Employer-based plans are referred to as group or workplace health coverage, and it is a policy that is purchased by an employer and offered to the eligible employees as a benefit.

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Health Insurance Terms Defined | Understanding Health Insurance

Understanding health insurance jargon will go a long way to helping you choose the right provider and making the most out of your plan.

When navigating the health insurance market, you will likely encounter terminology that seems unfamiliar. However, understanding exactly what a health insurance plan includes and what benefits a provider offers is essential to selecting the plan that’s best for you.

So, whether you’re shopping for health insurance or trying to figure out exactly what kind of coverage you have, understanding the jargon and common terms used in the health insurance industry will go a long way to helping you choose the right provider and make the most out of your health insurance plan.

Stop-loss insurance is a type of insurance purchased by corporate employers who have chosen to self-fund their insurance plans. Stop-loss insurance provides corporations protection from the full liability of incurring 100% of the losses a-sumed by catastrophic or unexpected employee medical cost claims.

Pharmacy benefit managers (PBMs) act as liaisons between pharmaceutical companies, wholesalers, pharmacies, and health insurance plan sponsors including health plans, labor unions, employers, and other organizations to negotiate prices and curate formularies (prescription benefit plan options) for optimal patient outcomes.

Although they sound attractive, prescription rebates do not directly lower patient costs on prescription medications. A patient’s prescription medication cost is based on a pharmaceutical company’s list price (similar to a retail price), and this is always the case.

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A Guide to Understanding Health Insurance Terms - Eden Health

Want to expand your health insurance vocabulary? We outline the health insurance terms and payment terminology should know. ✓ Learn more here!

Health insurance can be confusing, especially when it comes to understanding health insurance vocabulary and jargon. However, understanding health insurance terms is crucial, especially when selecting a health insurance plan. Whether it’s offered through your employer or you’re purchasing independent health insurance, it’s extremely important that you make the right choice for your specific healthcare needs. To help you make the best decision, let’s go over common health insurance terms and definitions.

You can’t make the right decision regarding an insurance plan if you don’t understand what it’s offering you. While the following terms don’t cover everything, here are some of the most important health insurance terms to know when choosing a plan:

Deductible: The deductible refers to the amount of money you need to pay on an annual basis to cover your medical expenses. After you reach your deductible amount, your insurance policy will begin covering the full cost of your medical expenses.

Copayment: The copayment, also known as a copay, refers to the flat fee you’ll pay for particular medical expenses. For example, you might pay a $20 copayment for a healthcare clinic or doctor’s office visit. It’s your responsibility to cover the copay; your insurance policy will pay for the rest of your visit. The copayment is one of the ways that you share your medical expenses with your health insurance company.

Rider: Riders refer to additional health insurance options you can add to your basic plan for an extra premium. Examples may include maternity coverage for expenses incurred during birth or personal accident riders for coverage if you suffer an injury from a serious accident.

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Understanding Health Insurance Terms | UnitedHealthOne

From "Coinsurance" to "Qualifying Event," "Deductible" to "Utilization," use this handy insurance glossary to learn the words and terms you need to know.

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When you know more about health insurance, you're in a better position to make choices for your health coverage. Here are some common health insurance terms to help you better understand your plan or even choose a new one.

Access – Your ability to receive medical care which can be affected by certain factors. Factors that impact access include your location and the kind of providers/facilities in your area. The provider network the insurance company offers impacts access – a particular doctor may not be in the network (using an out-of-network provider usually comes with a penalty, i.e., reduction in what the plan will pay). Your plan may limit access by requiring you to receive a referral from a primary care physician before you can see a specialist..

Actuary – Actuary is a person who works to calculate risk using statistics and mathematics. Actuaries help determine the premiums you pay. They calculate the dollars a company needs to pay claims.

Age Change – Date on which a person becomes one year older is an age change. Age is often one factor used to determine premium rates. Premium usually increases with age, reflecting normally increasing medical costs as an individual grows older.

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Understanding Health Insurance Terms | RenewBuy

Category: Health Insurance

Important as they are, health insurance terms are no less befuddling for the potential investors. In fact, with more and more health insurance options cropping up on a fairly daily basis, people tend to be more riddled about which is the most appropriate scheme. Accompanying any policy is the terms and conditions which are designed ingeniously. Consequently, laymen may find it extremely difficult in understanding health insurance terms.

Apart from these, a purely technical indulgence kind of petrifies the policyholder. Consequently, one is bound to misinterpret the possibilities. Therefore, it is imperative to educate the policyholder regarding understanding health insurance terms, common and otherwise.

Premium is the amount of coverage the policyholder shells out each month or year in order to avail the particular health insurance scheme. The premium policy varies from one company to another.

Generally speaking, the amount a policyholder needs to pay before the coverage officially takes effect. Also, it is important to keep in mind that deductible and premium are inversely proportional to each other.

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Common health insurance terms you need to know | MoneyUnder30

Category: Health Insurance

Health insurance is complex and often expensive. But understanding fundamental health insurance terms can ensure you choose the right plan.

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A premium is what you pay to maintain coverage; deductible is the amount you pay for treatment before the insurance company covers remaining expenses; copay is for routine medical services; and out-of-pocket maximum limits the total amount you pay each year for health care.

Even when insurers break down plan benefits in neat grids, the lexicon they use can still seem totally foreign. But it’s important to understand this stuff, particularly if you’re shopping for new health insurance coverage, or if you want to try to reduce costs with your current plan.

Health insurance should help people pay for healthcare expenses. Having insurance gives you an inexpensive way to get the medical attention you need, rather than only when you are ill or hurt. It also covers preventive care such as annual checkups, screenings, and other evaluations.

Health care is expensive, but it’s important to remember that health insurance isn’t only for times of illness or injury. It is possible to benefit from many preventive services provided by your insurance plan, designed to keep you healthy.

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Understand common health plan terms | UnitedHealthcare

Understand more about health insurance and read the definitions of common terms with UnitedHealthcare.

Working with health insurance can be confusing. At times, you might feel like there’s a whole new language to learn. To make it easier, here’s a list of common terms and what they mean.

A request for a benefit (including reimbursement of a health care expense) made by you or your health care provider to your health insurer or plan for items or services you think are covered.

You generally pay coinsurance plus any deductibles you owe. For example, if the health insurance or plan's allowed amount for an office visit is $100 and you've met your deductible, your coinsurance payment of 20% would be $20. The health insurance or plan pays the rest of the allowed amount.

The general term that refers to the share of costs for services covered by a plan or health insurance that you must pay out of your own pocket (sometimes called "out-of-pocket costs").

Some examples of types of cost sharing include copayments, deductibles, and coinsurance. Other costs, including your premiums, penalties you may have to pay or the cost of care not covered by a plan or policy are usually not considered cost sharing.

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Health insurance terms defined (Glossary) - CDPHP

An aggregate deductible is when the entire family deductible for a family health care plan must be met to receive a reimbursement from your insurance company. The deductible can be reached by one family member or a combination of members within the family. An embedded deductible is when individual members in a family health care plan only need to meet their own deductible before the health insurance company will reimburse service charges.

This is the most money that your insurance company will pay toward a health care service. If your bill for a health care service exceeds the allowed amount, you might have to pay the difference. This may also be called “eligible expense,” “payment allowance,” or “negotiated rate.”

This is the amount your doctor bills your health plan after providing you with health care services. This is not necessarily the amount your insurance plan will pay for these services, as health plans often negotiate payments with doctors to keep health care costs affordable.

An appeal is your opportunity to dispute your insurance company’s decision to not cover a certain health care service. In this situation, you can submit an appeal directly to your insurance company.

When your health care service bill exceeds the allowed amount stated by your insurance company, you then have to pay the difference between the allowed amount and the total charge from your doctor. In addition, there is an Out-of-Network state law mandated to create greater transparency within the health care system. The law protects patients from balance billing for “surprise bills” or emergency services bills from non-participating physicians. The law requires health plans to send notices to both members and providers when a claim – received for services from a NYS non-participating provider – was paid at usual and customary rates.

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Glossary of Health Insurance Terms | Blue Cross and Blue Shield of Illinois

The health insurance exchange will include a catastrophic plan option. Catastrophic plans have lower premiums but begin to pay only after you've first paid a certain amount for covered services, or just cover more expensive levels of care, like hospitalizations. Catastrophic plans are an option to consider for young adults and people for whom coverage would otherwise be unaffordable.

This stands for Consolidated Omnibus Budget Reconciliation Act of 1985. This federal act requires group health plans to allow employees and covered dependents to continue their group coverage for a stated period of time following a qualifying event that causes the loss of group health coverage. Qualifying events include reduced work hours, termination of employment, a child becoming an over-aged dependent, Medicare eligibility, death or divorce of a covered employee, among others.

The percentage of the costs of a covered health care service or prescription drug you pay after you've paid your deductible. You pay 100 percent of the full allowed amount until you meet your deductible.

A health plan with a health savings account (HSA) or other tax-advantaged account. Consumer directed health plans give members more control of health care expenses, as the deducible is higher and care is paid for with the health savings account.

When you need care and are on two different health plans, your insurers will coordinate your benefits to give you maximum coverage when you need it. It helps avoid duplicate payments and ensure the right payments are made by each plan.

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Understanding Health Insurance Basics Common Terms

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5 hours ago WebSome key health insurance terms to know include: 1. In-network providers Many health plans have a set of HCPs that they contract with. The HCPs who contract …

Just Now WebA health insurance plan with a high deductible. The amount of money you are responsible for paying out of pocket before your insurance begins paying is higher with this type of plan. However, …

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Understanding Health Insurance

Category: The Amount You Pay Your Insurance Company For Health Coverage Each

Learn the ins and outs of health insurance. Learn more about the terms, popular insurance types and coverages, and typical plan options.

Health insurance is one of the most important investments we ever make. Illnesses, injuries, and other medical setbacks can be astronomically expensive if hospital visits, surgery, or other serious measures are required; maintaining health coverage is the only way to ensure we aren’t stuck covering these emergency medical costs out-of-pocket.

Still, according to the Kaiser Family Foundation, more than 47 million non-elderly Americans ― roughly 15% of the country’s population ― were uninsured in 2012. These individuals paid approximately one-third of their medical expenses out-of-pocket, and faced higher bills than those with health coverage. According to a 2013 article from CNBC, more than 2 million U.S. residents were affected by bankruptcies stemming from high medical bills that year. Becker Hospital CFO notes that hospital stays alone generated costs of $387.3 billion in 2011, which averaged to roughly $10,000 per visit.

In order to obtain the proper level of coverage, you must understand how health insurance works. This article explores some of the fundamental concepts that govern the health insurance industry, as well as some of the most common sources of health coverage. Our goal is to ease the burden as you learn more about health coverage options and research different insurance policies.

Before we get started, a brief disclaimer: This article is intended to inform readers about the basic terminology and standard provisions of health insurance plans in the United States. Please contact a licensed health insurance agent or health insurance company directly for detailed information about individual/family plans before obtaining an insurance policy.

Let’s begin with a few key definitions. Understanding important terminology pertaining to health insurance is the first step to obtaining a cost-effective coverage plan that serves all of your individual or family needs.

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Understanding Common Health Insurance Terms

Category: Health Insurance

Navigating health insurance can be tricky. We’ve compiled a list of the most common terms you might come across to minimize any confusion in the terminology.

Diabetes is a chronic condition that requires consistent management. Staying well informed about the healthcare system and your coverage can help you make sure you get the care you deserve while avoiding excessive costs. Learning all the lingo when talking about health insurance can help you better understand how to get affordable care and advocate for yourself.

“Learning about insurance takes time,” said diaTribe’s Community Manager, Cherise Shockley, “but the more an individual with diabetes understands, the better decisions they may make, whether it be choosing an endocrinologist, primary care provider, medicine, insulin, or diabetes device.”

We’ve compiled a list of common terms that come up when discussing health insurance. Use this glossary whenever you’re navigating the healthcare system or want a better explanation of a term you saw in our Access series.

Premium – Similar to paying rent, a premium is a fixed amount that you pay every month to keep your health insurance active. It is common for employers to pay about half of your monthly premium, and sometimes more. In 2019, people with employer-sponsored health insurance paid an average of $1,242 a year on health insurance premiums.

Deductible – A deductible is the amount you pay out-of-pocket before your insurance provider covers medical expenses. For example, if you have a $1,000 deductible, your insurance coverage will not kick in until you’ve paid $1,000 in healthcare expenses for that year.

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Understanding Health Insurance terms chapter1 & 2

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| Medica

Whether you’re one of the record number of Americans who signed up for health coverage in 2022 through an Affordable Care Act marketplace, or if you have coverage through an employer or government program, the terms used in medical insurance can be confusing. Understanding them will help you get the most out of your policy. Here are several terms to keep in mind.

PREMIUM. Perhaps the easiest term to understand, health insurance premiums are monthly amounts you pay to your health insurance provider to retain coverage. For coverage provided by an employer, most of the premium generally is paid by them. Your portion typically is deducted from your paycheck.

Preventive services such as annual check-ups, routine screenings, vaccinations and immunizations are covered at no cost when delivered by a doctor or other provider in the health plan’s network. Deductibles, copays and coinsurance do not apply.

DEDUCTIBLE. The deductible is the amount you pay before your health insurance kicks in and begins covering your medical costs. Deductibles vary in prices and coverage. Some policies apply your deductible to all medical services, while another might have separate deductibles for different services, like prescription drugs.

COPAYMENT. Copayments, or copays, are set fees that you pay for a health care service during a visit to the clinic or hospital. Copays are flat rates that can vary by plan and from one service to another. For example, you might have one copay amount for routine visits to your primary care physician, a higher copay for specialists, and yet another amount for prescription drugs.

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Understanding Health Insurance Terms | EBS

Category: UNDERSTANDING HEALTH INSURANCE TERMS

CoinsuranceThe portion of eligible expenses that plan members are responsible for paying, most often after reaching a deductible. An example of coinsurance could be that your health plan covers 70% of covered medical charges and you are responsible for the remaining 30 percent.

Covered ServicesServices or supplies for which your health plan will pay (or “cover”) all or a portion of the cost. Most health plans do not cover all services and supplies, and it is important to be aware of any limitations and restrictions that apply to your covered services.

Medically Necessary ServicesServices or supplies which are appropriate and necessary for the symptoms, diagnosis, or treatment of a medical condition, and which meet additional guidelines pertaining to necessary provision of medical or mental health care. Services must be medically necessary in order to be covered.

In-NetworkA group of physicians, hospitals, and other health care providers who participate in a specific network arrangement plan. When you receive care from an in-network provider, you pay only a copayment and/or coinsurance for covered services. These providers have contracted with the network for preferred pricing on services in most instances.

Out-of-Pocket MaximumWhen the deductible and coinsurance amounts you have paid in a plan year add up to the out-of-pocket maximum, the health plan will begin covering 100% of eligible charges for the remainder of the year.

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Health insurance plans for individuals & families, employers, medicare | UnitedHealthcare

See what UnitedHealthcare can do for you. Explore employer, individual & family, Medicare-Medicaid health insurance plans from UnitedHealthcare.

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Understanding Health Insurance Terms

Category: Health Insurance Terms

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(3 days ago) People also askHow to understand your costs and key health insurance terms?How to understand your costs and key health insurance terms?Your health insurance company will have a list of drugs covered by your policy. You also may be able to find out if a particular drug is covered by calling your health insurance company's customer service number.If your medication is covered, how much you'll pay depends on your particular policy. Understanding Health Insurance - MedicalBillingandCoding.org

(5 days ago) WebSome key health insurance terms to know include: 1. In-network providers. Many health plans have a set of HCPs that they contract with. The HCPs who contract …

(8 days ago) WebPremium – The amount that you pay in order to have health insurance. This is usually paid monthly, quarterly or yearly by you and/or your employer. Copayment – A fixed amount you pay for a covered health …

(Just Now) WebShort term health insurance plans provide you with coverage for a limited period of time, and may be an ideal solution for those between jobs, waiting for other health insurance …

(2 days ago) WebCopayment or Copay. A health insurance term that pertains to the amount you pay for a health care service, like a doctor visit or a trip to urgent care. The amount depends on …

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