You’re not alone if confusing health insurance terminology is making your head spin. Fortunately, health insurance coverage is relatively easy to understand once you have a basic understanding of the common terminology. In this straightforward breakdown, we’ll cover the most common health insurance terms and how these plan characteristics affect your coverage, budget, and health considerations.
Understanding Common Health Insurance Terminology
Understanding the key differences between the most common plans is a great place to start. While considering which plan option is right for you, take the time to compare overall cost, range of medical services included, and how accessible are the services covered under your plan. A few of the major plan options and key differences to consider include:
- DEDUCTIBLE: This is the amount of money you are required to pay for health care services before your insurance company begins to pay. Many plans involve a maximum out-of-pocket deductible, so once you have met the maximum threshold, the insurance company will cover any future in-network services defined by the plan.
- PREMIUM: Simply the cost of your plan each month. Plans with lower deductibles often include a higher premium, and plans with higher deductibles often involve a lower monthly premium.
- CO-PAY: Your portion of the cost of a medical appointment or item, such as a standard checkup or medication. Every plan is different, but your coverage terms should clearly define your co-pay obligations associated with each covered service.
- NETWORK: Your insurance network is the group of medical providers that have a contracted agreement with your insurance company. Any in-network coverage refers to medical services received within the specified group of providers.With out-of-network services, you may need a referral from your primary physician (if you are a member of an HMO plan) and should verify if you will receive partial coverage for any out-of-network services before making an appointment. Plans like PPO/POSs will cover partial out-of-network expenses in most cases.
- COINSURANCE: The amount of money you owe for a partially covered service. Your plan may have a separate section for specialty services or surgeries that is different from the coverage you receive for basic services. For example, your coinsurance may cover 80% of surgery, and you are responsible for the remaining 20%.
Choose A Plan That Supports Your Goals
After learning the health insurance essentials, the next step is to compare your current plan with the best available options. If your deductible is too high, you don’t have access to the providers you need, or you’re paying a premium that seems a bit excessive, there are a wealth of providers hoping to entice new members with more affordable rates, expansive networks, and flexible service options for diverse medical needs.
While comparing the options that better address your healthcare needs and protect your budget, you can partner with an Insurance Broker in NYC to help you simplify the process. With experienced guidance, you can often find a plan that offers the same (or better) coverage for less, with additional considerations included like partial out-of-network coverage or a more reliable network of providers in your area.