Do You Know These Health Insurance Terms?

If you’ll soon secure your own health insurance for the first time, or if it’s been a while since you switched coverage providers, there may be insurance terms you aren’t familiar with. To help you feel more confident about selecting the right policy with help from an experienced health insurance broker Santa Rosa, Sackett & Associates Insurance Services wants to ensure you know these 10 health insurance terms.

1. Preventative Care

These are health care services you tap when you feel healthy and well-balanced to stave off sickness. Preventative care includes services such as patient counseling, yearly physicals, immunizations and screenings. As long as you receive preventative care from a physician in your plan’s network (more on this later), you likely do not have to pay a coinsurance or co-pay fee.

2. Premium

Premiums are the amount you pay to maintain your health insurance coverage. You can pay premiums every year, quarter or month.

3. Out-of-Pocket Maximum

This is how much you pay for medical services each policy period before your insurance provider covers all services included with your plan. Co-pays, deductibles and coinsurance contribute to this maximum, but not your regular premiums.

4. Out-of-Pocket Cost

Out-of-pocket costs are what you pay for medical services. Examples of such costs include co-pays, deductibles and coinsurance.

5. Out-of-Network

Physicians, health care facilities and other health providers who do not accept your health insurance are “out-of-network.” While insurance companies do not forbid you from seeing out-of-network providers, companies do not help pay for services received from those providers.

6. In-Network

The opposite of out-of-network, “in-network” providers work with your insurance company. Before receiving health services or picking up prescriptions, double-check that you see the facility, pharmacy or doctor on your provider’s list of approved practitioners and facilities.

7. Essential Health Benefits

These are specific health services all insurance providers in the Health Insurance Marketplace must offer. Examples of these benefits consist of pediatric services, newborn/maternity care, emergency services, mental health and hospitalization.

8. Deductible

Your deductible is the out-of-pocket amount you pay before your policy activates. If you have a $40 deductible, your insurance doesn’t kick in until you pay $40.

9. Copay

Health care supplies and services included in your policy may require a copay. Similar to a deductible, copays are a sort of fee requirement that your insurance company requires before taking care of your medical care. For instance, you may have a $25 copay for all physician visits or prescriptions.

10. Coinsurance

This is your portion of the medical service bill once you take care of any deductible you owe. For example, if your therapist charges $100 a session and your health insurance plan has a 20% coinsurance requirement, you only pay $20 for a session as long as you’ve already paid your deductible.

Hopefully, you feel more confident about reviewing and choosing the right health policy. For more information, or to get help narrowing your options, contact a Sackett & Associates Insurance Services representative today. Fill out and submit an online form, or call us whenever you’re ready at 707-823-3689.