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10 Health Insurance Terms You Should Know

A helpful collection of health insurance terms everyone should know before enrolling any insurance plan.

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10 Health Insurance Terms You Should Know

Last Updated on: 17th September 2023, 10:08 am

A lot of Americans will have the opportunity to modify their healthcare plans as soon as open enrollment begins. But let’s be honest, if you don’t know the difference between a premium and a deductible, it could be difficult to select the finest coverage. Our guide steps in to help with that. Before choosing a new plan, you should understand these 10 often used healthcare phrases.

You can make a financial plan for your medical requirements and expenses with the assistance of a financial counsellor.

10 Health Insurance Terms to Know Before Enrolling

#1. Deductible

An annual health service deductible is the amount you are responsible for paying out-of-pocket before your insurance company begins to cover its portion. For instance, if your deductible is $1,000, your insurance plan may not begin paying its share of your expenses until you have spent $1,000 on medical care in a given year. Even before you’ve reached your full deductible amount, plans frequently cover expenses like preventive care doctor visits.

#2. High deductible health plan (HDHP)

A higher deductible than what most people is required if you have a high deductible health plan (HDHP). Your out-of-pocket costs will increase, and your insurance’s coverage will be limited until your deductible is fully paid. Your premiums will be lower in return, and you may be able to open a health savings account that allows you to set aside pre-tax money for paying for medical expenses.

Plans with deductibles of at least $1,400 for individuals and $2,800 for families are classified as HDHPs for 2022. They may help you save money, and younger people and those who don’t require extensive medical care but want low premiums may find them particularly helpful. An HDHP can be pricey, however, if you accrue a lot of medical expenses in a single year.

#3. Health Savings Account (HAS)

A health savings account (HSA) is a type of savings plan for potential medical costs.

In 2022, individuals may contribute up to $3,650 (or $4,650 if you’re at least 55) in pre-tax funds to be used for medical expenses through a health savings account (HSA). Your contributions reduce your tax liability, and any withdrawals used for qualified medical expenses are tax-free.

A flexible spending account (FSA), which is associated with your job and enables you to save pre-tax money for out-of-pocket medical expenses, is different from an HSA. While FSA funds must be used up before the end of the plan year because they typically do not roll over, unused HSA funds remain in your account until you need them.

#4. Premium

Your premium is the fee you pay to the insurance provider in exchange for the right to use an active insurance policy. The majority of people make their payments every month, but it’s possible that you have quarterly or annual payments.

Fortunately, tax credits can be used to reduce the price of health insurance premiums for plans bought through the Affordable Care Act marketplace. Your employer likely contributes to the cost of your monthly premium if you have health insurance through your job.

#5. Copayment

You must pay a copayment (or copay) each time you obtain a certain kind of medical service. Depending on the type of service you’re receiving, copays may change. For instance, you might have to fork over $30 for each visit to your primary care physician and $60 for each visit to a specialist.

Copayments typically cannot be used to reduce your deductible. To find out how your coverage operates, though, you’ll need to study the tiny language of your plan.

#6. Coinsurance

You are still responsible for paying your medical expenditures even after you have reached your deductible for the year. Usually, you’ll have to pay some coinsurance. That is the portion of medical costs that you will shoulder. For instance, if you reach your $2,500 deductible in May, your subsequent coinsurance will be 20%. This means that out of a $100 bill, you would pay $20 and the insurance company would cover the remaining $80.

#7. Maximum Out of Pocket Costs  

The term “maximum out-of-out charges” refers to the most you will have to spend out of pocket each year for medical care. Your copay, your share of the coinsurance, and the deductible itself are all included in this sum. But it excludes surcharges and specialised services like massage.

Your annual maximum payment for expenditures such as your deductible, copay, and coinsurance is this sum. The maximum barrier for single coverage in 2022 is $7,050; for family coverage, it is $14,100. Let’s say you go the entire year without incurring any medical costs and then you find yourself in the hospital. Assume that according to your plan, the insurance provider will cover 70% of hospital costs while you are responsible for 30% (your coinsurance). You won’t have to pay any more than that even if your 30% part of the bill is higher than $7,050 because your yearly out-of-pocket maximum will already have been reached.

Your insurance provider will cover the remaining costs of your care as long as they are necessary after you’ve reached the maximum. The out-of-pocket maximum does not include premiums or other therapies like acupuncture and hearing aids. Out-of-network costs might not count toward your out-of-pocket maximum if your plan makes a distinction between in- and out-of-network providers.

#8. HMO (Health Maintenance Organisation)

You may have the least level of provider selection freedom under a health maintenance organisation (HMO) plan. Be ready to foot the entire medical bill (unless there is an emergency) if you don’t see a doctor who either works for the HMO as an employee or on a contract basis. You can lose your coverage if you move or change to a job in a different city.

#9. POS (Point-Of-Service)

You require a reference from your primary physician in order to receive care from a specialist under a point-of-service (POS) plan. If you see a doctor who is not in your insurance’s network, your medical costs will be higher, but on the plus side, you’ll probably have more options for doctors than you would with an HMO.

#10. PPO (Preferred Provider Organisation)

When you see a physician or specialist outside of your network under a preferred provider organisation (PPO) plan, your insurance company may cover a percentage of your medical expenses. Although you’ll probably spend extra, you won’t require a recommendation from your primary care physician to do it. You should continue using in-network healthcare providers to minimise costs.

Conclusion:

Finding a plan that satisfies your demands and falls within your budget should be possible if you have a solid understanding of the meanings of the major healthcare buzzwords. When looking for health insurance, excellent coverage and low cost are typically trade-offs.

The plans with the highest provider freedom and the lowest deductibles typically have higher rates. Cheap plans can be a fantastic value in a year of good health, but they might be an expensive option if you have a lot of medical costs.

I am a freelance writer and editor with more than 10 years of experience crafting content for both small businesses and major publications. I have a keen eye for detail and a knack for taking complex topics and making them easy to understand for the average reader. My goal is always to produce the best possible content for my clients, whether it be for website articles, blog posts, or even marketing collateral.