If you don’t know much about healthcare, there may be some terms you are not familiar with. Before you learn the pros and cons of different healthcare plans, you need to learn these terms. The words we will cover are premium, deductible, coinsurance, co-pay, networks, and out of pocket maximum.

Premium

The premium is what you pay every month for health insurance coverage. It is a set amount. Sometimes your employer will pay a portion of your premium.

Deductible

But insurance doesn’t immediately start paying for all your medical costs. Most plans have a deductible, which is the amount you pay before health insurance starts paying for medical expenses. 

Coinsurance

After you reach your deductible, you enter the coinsurance phase. This means you pay a percentage of medical costs, and insurance covers the rest.

Out-of-Pocket Maximum

But you don’t pay coinsurance forever. Each year, there is a maximum amount that you’ll ever pay out-of-pocket. That’s called the out-of-pocket maximum.

Networks

What about Networks? What does it mean to be in-network or out-of-network?

Health insurance companies contract with doctors and facilities to provide lower rates to their members. If a provider or facility is in-network, that simply means your insurance company has contracted with them. 

It is a smart move to contact your insurance company to see if the provider you are going to see is in-network or out-of-network. Often, out-of-network providers and facilities are subject to higher deductibles and max out of pockets than in-network, meaning members will end up paying more money. 

Co-Pay

Lastly, we have the co-pay. This is simply a fixed payment you make to your provider before receiving medical care. Not all plans have co-pays.

How does my plan compare to others? 

Now that you know how to speak healthcare, you can start to learn the benefits of different types of plans and find the plan that best fits you.