Health insurance is an important part of protecting your health and your wallet, but let’s face it, the terminology can be overwhelming. If you’ve ever read your plan documents and felt like you needed a translator, you’re not alone.
Here’s a plain-language guide to the most common terms so you can make sense of your coverage and use it with confidence.
Deductible
This is the amount you pay out-of-pocket for covered medical services before your insurance starts paying. For example, if your deductible is $2,500, you’ll pay the first $2,500 in covered expenses yourself before your plan kicks in.
Coinsurance
After you’ve met your deductible, coinsurance is the percentage of costs you share with your insurance company. For example, with 20% coinsurance, you’d pay $20 of a $100 bill and your plan would cover the other $80.
Copayment (Copay)
A set amount you pay for certain services, such as $35 for a primary care visit or $10 for a prescription. Copays often don’t count toward your deductible.
Out-of-Pocket Maximum
This is the most you’ll have to pay for covered services in a plan year. Once you reach this amount, your plan pays 100% for covered services for the rest of the year.
Premium
The amount you pay each month to keep your health insurance coverage active.
Network
A group of doctors, hospitals, and facilities that contract with your insurance company. Using in-network providers usually means lower costs.
Why This Matters
When you understand these terms, you can better predict your costs, choose the right plan, and avoid surprises. Health insurance doesn’t have to be a mystery, a little knowledge can go a long way in protecting your health and your budget.
Have questions about your health coverage or choosing the right plan? Contact us at 800-637-4676 or info@profinsprog.com — we’re here to help.