Top 16 Health Insurance Terms to Know
The Affordable Care Act makes health care available to more people. For many, this will be the first time they’ll use a health insurance plan. Health insurance, like many other things in life, has terms to describe certain things. In this post, we’re going to look at a few of the most commonly used health insurance terms to know.
1. Affordable Care Act- the ACA is the federal law that was passed by Congress and signed into law in March 2010.
2.
Health Insurance – helps pay part of the cost when you’re sick or hurt.
Health insurance is a contract between you and your insurance company. You buy a health plan from the company. They agree to pay some of your medical costs when you are sick.
3. Premium – this is the amount that you pay for your plan. For some qualified people, the government may provide a subsidy to help pay this amount.
4. Covered Services – this describes what is covered, or able to be paid for, by your health plan. It’s important to know what is covered to help save money.
5. Benefit - this is the amount that your insurance company will pay for covered services.
6. Exclusion – these are items that are not covered under the plan. The cost for these services is usually full price and you will pay for out-of-pocket.
7. Provider – this is used to describe any provider of service – including doctors, hospitals, and pharmacies.
8. Network – the facilities, providers and suppliers that contract with your insurance company to provide medical services. Using these providers, also known as “staying in-network,” is one way to save money.
9. Non-participating – this describes a doctor or provider that doesn’t have a contract with your insurance company. Services for these providers typically cost more because they are not in-network.
10. Claim – this is a request for payment from your provider to your insurance company to be paid for medical services.
11. Allowed Amount – this is the maximum amount that your insurance company pays for medical services. The deductible, copay and coinsurance are based on this amount.
12. Coinsurance – this is your share of the costs of a covered health care service, calculated as a percent. This usually comes into play after meeting your deductible.
13. Copay – this is a set dollar amount, or fee; you pay for a covered health care service, usually when you receive the service.
14. Deductible – this is a fixed dollar amount that you pay before your insurance company starts to pay for covered services. This amount is set up front and is typically good for a period of one year.
15. Out-of-Pocket Maximum - this is the maximum amount that you or your family pays for a set period, usually a year, before the insurance company picks up your copays, coinsurance and other out of pocket expenses. It’s important to note that the maximums are typically different for in- and out-of-network providers and these two amounts are usually not combined.
16. HSA (health savings account) – this is a savings account that you can put money into to help pay for medical expenses. You are not taxed on the money you add. You have to have a qualifying plan to have an HSA and this is regulated by the government.
This just covers a few of the most commonly used health insurance terms and definitions that you’ll come across in using your insurance plan. I enjoy hearing from each of you so please take a minute to drop me a line and let me know about some terms you have come across.
This is a representation of what usually happens when someone tries to sign up by themselves on the government Healthcare reform website. You will get eaten alive. There are so many ways to go wrong. Input just one piece of data in the wrong spot or not be entirely sure as to what they count as income and what they don't and you can be in for a bunch of grief. There are many plans with multiple networks and different coverage levels that making a poor choice could impact your finances for years to come. Let Berlin & Denys Insurance help and we do all the leg work and the best part is that the cost is exactly the same as if you did it all by yourself. Actually, it is probably lower in cost because you will get the proper subsidy and the right plan. Give us a call today at 800-946-3303 or visit us on the web at http://www.berlindenys.com for immediate help.
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