terms to know

new job starter pack (full-time)

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what's in this lesson?

When it comes to health insurance, it kinda seems like there are an endless number of terms we need to learn to make sense of it all. Let us make it easy for you–be sure to give these some attention before you pick a health insurance plan.

terms to know

new job starter pack (full-time)

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  • Overview
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terms to know

new job starter pack (full-time)

When it comes to health insurance, it kinda seems like there are an endless number of terms we need to learn to make sense of it all. Let us make it easy for you–be sure to give these some attention before you pick a health insurance plan.

Let’s walk through some key health insurance terms and definitions:

 

premium is a payment you make (generally monthly) to your health insurer to get health insurance coverage. When you have employer-sponsored health insurance, it comes right out of your paycheck. Otherwise, it’s a monthly expense. Yeah, sucks.

 

deductible is the annual amount you would have to pay in health care expenses before your insurance starts kicking in and covering a portion of your expenses. So, say your deductible is $5,000, and you went to the hospital for a visit that cost $4,000, your insurance wouldn’t help cover your medical costs until you’ve spent another $1,000 in medical expenses that year. (Note: co-pays, presecription payments, and some other standardized costs in your plan are exceptions – your insurance automatically covers a portion of those).

 

Coinsurance is a term you need to know after you’ve hit your deductible. This refers to the percentage of your health care post-deductible that you still have to pay on every bill.

 

Co-pays are fees that you pay health care providers for every service. Not every plan has co-pays.

 

Out-of-pocket maximums consider all the money you’ve spent across your deductible, coinsurance, and co-pays. Out-of-pocket costs are what they sound like – you’re paying for them out of your pocket. At a certain point, your plan won’t require you to spend any more money and the insurer will cover ALL additional costs–that’s the out-of-pocket maximum.

 

Networks refer to the doctors that accept certain insurance plans. So if you have insurance through Blue Cross, for example, any doctor that takes that insurance plan through Blue Cross would be “in-network” for you. You could see that doctor and your health insurance will cover part of your care. And each network will have an online directory you can check to find nearby doctors in-network. (Note: Certain plans also cover some expenses for out-of-network health care providers, but it’s typically far less than in-network providers).

 

Pre-authorization is when your health insurance confirms that an upcoming service is medically necessary. Although, be careful – this does not necessarily mean that the insurer will cover all of your medical expenses. It typically means they’ll cover a portion of the services performed and you may be responsible for part of it, too. So, when you hear a service is “approved by insurance” be sure you get the details on exactly what and how much is approved so you know what you’re responsible for.

 

So, with all these terms in mind–you need to find a balance for your medical needs and priorities. Check out the next lesson where we talk through different types of health insurance plans.

 

Source(s): healthcare.gov

what's in this lesson?

When it comes to health insurance, it kinda seems like there are an endless number of terms we need to learn to make sense of it all. Let us make it easy for you–be sure to give these some attention before you pick a health insurance plan.

Transcript

Let’s walk through some key health insurance terms and definitions:

 

premium is a payment you make (generally monthly) to your health insurer to get health insurance coverage. When you have employer-sponsored health insurance, it comes right out of your paycheck. Otherwise, it’s a monthly expense. Yeah, sucks.

 

deductible is the annual amount you would have to pay in health care expenses before your insurance starts kicking in and covering a portion of your expenses. So, say your deductible is $5,000, and you went to the hospital for a visit that cost $4,000, your insurance wouldn’t help cover your medical costs until you’ve spent another $1,000 in medical expenses that year. (Note: co-pays, presecription payments, and some other standardized costs in your plan are exceptions – your insurance automatically covers a portion of those).

 

Coinsurance is a term you need to know after you’ve hit your deductible. This refers to the percentage of your health care post-deductible that you still have to pay on every bill.

 

Co-pays are fees that you pay health care providers for every service. Not every plan has co-pays.

 

Out-of-pocket maximums consider all the money you’ve spent across your deductible, coinsurance, and co-pays. Out-of-pocket costs are what they sound like – you’re paying for them out of your pocket. At a certain point, your plan won’t require you to spend any more money and the insurer will cover ALL additional costs–that’s the out-of-pocket maximum.

 

Networks refer to the doctors that accept certain insurance plans. So if you have insurance through Blue Cross, for example, any doctor that takes that insurance plan through Blue Cross would be “in-network” for you. You could see that doctor and your health insurance will cover part of your care. And each network will have an online directory you can check to find nearby doctors in-network. (Note: Certain plans also cover some expenses for out-of-network health care providers, but it’s typically far less than in-network providers).

 

Pre-authorization is when your health insurance confirms that an upcoming service is medically necessary. Although, be careful – this does not necessarily mean that the insurer will cover all of your medical expenses. It typically means they’ll cover a portion of the services performed and you may be responsible for part of it, too. So, when you hear a service is “approved by insurance” be sure you get the details on exactly what and how much is approved so you know what you’re responsible for.

 

So, with all these terms in mind–you need to find a balance for your medical needs and priorities. Check out the next lesson where we talk through different types of health insurance plans.

 

Source(s): healthcare.gov

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