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Health insurance terms you should know

Have you ever felt intimidated by health care and health insurance terms? If so, you’re not alone. Studies show that only about one in 10 people in the U.S. have a proficient level of health literacy. However, understanding health terms can save you time, money, and stress.

That’s why we created a health insurance dictionary including important terms to know. Happy learning!

 

GoHealth’s Health Insurance Dictionary

Affordable Care Act (ACA)

Known officially as the Patient Protection and Affordable Care Act, or Obamacare, the ACA is the healthcare reform legislation signed into law by President Obama is 2010.

Coinsurance

Similar to a copay, but it’s a percentage of the cost you owe to see your doctor, not a set price. Coinsurance can end up costing you more money, because unlike a copay, you don’t know how much any given doctor’s visit could cost. Like copays, coinsurance does not count toward your deductible. However, they both count toward your out-of-pocket maximum.

Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)

COBRA is a federal law that enables you to temporarily keep a group insurance plan through your employer should you leave your job or change to part-time hours.

Copay

The set amount of money you pay when you go to the doctor. Your copayment will depend on the type of plan you choose. Copays do not count toward your deductible but they do count toward your out-of-pocket maximum.

Deductible

The amount of money you have to pay out of pocket when you see a doctor before your health insurance starts to help with costs. Your deductible amount will depend on the type of plan you choose. Plans with lower monthly premiums usually have higher deductibles, but plans with higher monthly premiums have lower deductibles. If you anticipate going to the doctor often, a plan with a lower deductible could be in your best interest, since you’ll have to pay out-of-pocket until you reach your deductible. Keep in mind that deductibles reset and can change every year.

Dependents

Dependents are those that receive coverage on their family members plan. Under the Affordable Care Act, dependent coverage for children must be made available until age 26.

Essential health benefits
The Affordable Care Act requires health plans to cover benefits in ten categories. Non-grand fathered health plans must cover pediatric care, hospitalization, maternity care, newborn care, care for mental health and substance use disorders.

Flexible Spending Account (FSA)

Money that is taken out of your paycheck and put toward an account owned by your employer. This money can only be spent on your health care expenses, but it does not roll over year to year or if you change jobs. Therefore, if you know for certain you will have health care costs this year, this might be an option.

Grandfathered health plans
Health insurance plans that were purchased on or before March 23, 2010. These plans do not have to abide by any provisions of the Affordable Care Act.

Health Insurance Marketplace

Otherwise known as the affordable insurance exchange, these exchanges exist at the state and federal levels and allow individuals, families, and small businesses to evaluate their health coverage options and compare plans based on prices and coverage. You can enroll in coverage during Open Enrollment, which happens once per year.

Health insurance plans in the health insurance marketplace are divided into four categories: Bronze, Silver, Gold, or Platinum. To find out which type of plan is right for you, visit our website or call (888) 322 – 7557 to speak with a licensed agent.

Health Savings Account (HSA)

Money that is taken out of your paycheck and put toward an account you own that can be spent only on health care expenses. The money taken out of your paycheck is tax-free and can roll over year to year.

In-network provider

A doctor that is approved by your insurance company. You can look online or call your insurance provider to find a doctor in your network. Going to a doctor in your network can save you money, but how much money depends on your plan.

Medicaid
Government-funded health care program that helps provide coverage for individuals and families with low incomes and with disabilities.

Medicare
Federal health care program for people over the age of 65 and younger people with specific disabilities.

Open Enrollment

The time period in which you can choose and sign up for next year’s health insurance. This year, Open Enrollment for coverage in 2018 starts November 1, 2017. Outside of Open Enrollment, the only way you can purchase health insurance is if you’ve had a qualifying life event.

Out-of-pocket maximum

The maximum amount you can spend on health care in a given year. Once you reach your out-of-pocket maximum, you’ll no longer have to pay copays and coinsurances for essential health benefits. However, for non-essential health benefits, the insurance provider might have limits on how much of your care it will cover.

Out-of-network provider

A doctor not in your network. Seeing a doctor outside of your network outside of an emergency may result in higher out-of-pocket costs.

Premium

Your monthly bill for health insurance. To activate your health insurance, you must pay your first premium. Your monthly premium will depend on the type of plan you choose. Failure to make premium payments could result in loss of health coverage.

Preexisting condition
Specific illnesses or conditions that you had prior to purchasing health insurance. Under the Affordable Care Act, health insurance plans can no longer deny coverage or charge you more due to pre-existing conditions.

Preventive services
Preventive services are services that prevent illness and disease. Preventive services include routine check-ups, mammogram screenings, colonoscopies, blood pressure screenings and certain vaccines. The Affordable Care Act requires that preventive services be 100% covered by your health insurance plan.

Qualifying Life Event

A specific change in your living situation – like getting married, having a child, or losing health insurance – that can make you eligible for a Special Enrollment Period.

Special Enrollment Period

The time outside of the annual Open Enrollment Period where you can sign up for health insurance if you experience a qualifying life event.

Have questions about any of these terms? Visit our GoHealth.com or call (888) 322 – 7557 to speak with one of our experts.

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