Confused by Insurance Terminology? Look No Further

We’re in the midst of Open Enrollment, the period during which individuals and families can enroll, re-enroll, or change their health insurance plan for 2018. This year, Open Enrollment runs from November 1, 2017 to December 15, 2017.

Many Americans have already enrolled in 2018 coverage. However, for those who haven’t, there may be confusion. Should you select a high-deductible play or low-deductible plan? What’s the difference between a PPO, HMO, and EPO? To help guide you in your search, we’ve pulled together a list of the most useful terms to know when selecting a health insurance below.

Premium: The monthly cost of your health insurance plan. If you get an employer-sponsored insurance plan, the premium might come out of your paycheck.

Copay: This is the flat rate you’re charged for doctor visits and prescriptions. The rates vary according to the service, so having a general idea about what kinds of healthcare visits you will make might help assess these rates.

Deductible: The amount you have to pay for health services before your insurance plan starts to pay. Deductibles do not apply to monthly premiums or free preventative services such as checkups. If you are a relatively young and healthy person, you may prefer a plan that has lower premiums and higher deductibles, which means you will be paying less at a monthly basis but if you do require a health service you may have to cover a big amount of it.

Coinsurance: This is the percentage of costs you have to pay after you’ve met your deductible.

Out-of-pocket maximum: This is the most you would have to pay for health insurance in a given year for the services your plan covers. So once you hit that out-of-pocket maximum, your insurance company covers everything.

Cost-sharing: The share of costs covered by your insurance that you pay out of your own pocket. This term generally includes deductibles, coinsurance, and copayments, or similar charges, but it doesn’t include premiums, cost of non-network providers, or non-covered services.

Preferred Provider Organization(PPO):  A type of health insurance plan that has a broad list of participating providers and hospitals for which you pay less. In a PPO, you can also use out-of-network doctors at a higher cost.

Health Maintenance Organization (HMO): A type of health insurance plan that limits coverage to in-network doctors and the hospitals that work with those doctors. HMO’s typically won’t cover out-of-network care unless it’s an emergency and requires a referral from the primary care physician to see a specialist.

Exclusive Provider Organizations(EPO): A type of health insurance plan that allows individuals to use the doctors and hospitals within the EPO network, but won’t cover care that goes outside of the network. In EPOs, there are no out-of-network benefits or requirements to get a referral to see a specialist.

For additional health insurance terms you may not be familiar with, visit https://www.healthcare.gov/glossary/.

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