What Are Key Words You Need To Know When Shopping For Health Coverage?

Understanding all of the terminology that goes along with health insurance is very tricky.  Do you understand the difference between your health insurance coinsurance and copay?  If your answer is no, then you may want to brush up on your health insurance terminology.  Here are the top 20 health insurance terms you should know.

1. Essential Health Benefits:

Under the Affordable Care Act (ACA), you are eligible for specific benefits when you buy health insurance.

2. Deductible:

This is the amount you need to pay for covered services until your health insurance plan kicks in.  Additionally, it is important that you understand that copays and all premiums do not count toward your deductible.

3. Co-payment:

Your co-payment is a predetermined amount which you pay for a specific service.  Your plan may have a $15 copay each time you go to your primary care physician and a $40 copay when you go to a specialist..

4. Coinsurance:

This is your share of the expense of a covered service.  For instance, your plan may have a 20% coinsurance.  If the program permits $200 for a treatment, you will owe $40.

5. Premium:

The amount you pay for your plan every month.

6. Negotiated Rate:

This is the maximum amount your policy permits for a specific service.  You might need to pay the difference if you are using an out-of-network provider.

7. Appeal:

If your claim was denied, you can appeal it.  You are owed a written explanation concerning the refusal of coverage by your insurance company.  They need to advise you how you can go about appealing your decision.

8. Balance Billing:

When you receive a bill for the difference between the providers charge and the allowed amount negotiated.

9. Benefits:

Benefits are the services which are insured under your individual plan.  They should be spelled out on your account or your policy records.

10. Bronze:

Bronze is a plan category.  Categories are based on how much protection (by percent ) you are covered.  These plans are:

Catastrophic: less than 60% (accessible only to individuals under 30 or people using a hardship exemption)
Bronze: 60%
Silver: 70%
Gold: 80%
Platinum: 90%

11. Claim:

Normally, a provider will submit a claim to the insurance of the services it provided to you.  You can submit a claim yourself, if the provider does not.

12. Grandfathered Plan:

A grandfathered plan is strategies which were made or bought before or on March 23, 2010 and therefore are exempt from some of these principles of the ACA.

13. Out of Network:

When you use out-of-network providers, you will have a copay and coinsurance that is higher than if you choose an in-network provider.  You might have two different deductibles for out and in network providers.  You save money by picking in network providers.

14. Exchange: 

Exchange is also known as the Health Insurance Marketplace.  The exchange helps people shop for and enroll in affordable medical insurance.


15. Minimum Crucial Coverage:

This identifies the very fundamental coverage required for somebody to satisfy their obligation under the ACA. Vision, dental, or programs that cover provide discounts or particular conditions are not enough.

16. Out of Pocket:

This is what you can expect to pay from your pocket. Co-pays, deductibles, and coinsurance are out of pocket expenditures.

17. Pre-authorization:

Occasionally, your provider will ask that you get authorization for services.  Without pre-authorization the provider may not be able to provide services.

18. Main Care Provider:

That is your principal health care provider.

19. Qualifying Life Event:

That is a change which makes you qualified to buy health insurance out of open registration.

20. Premium Tax Credit:

A premium tax credit is a credit you can take in advance to lower your monthly health insurance payment.  After you apply for health coverage, you can estimate your income for the year.  Based on this estimate you can determine if you qualify for a premium tax credit.  You can use the credit to lower your premium.

Now that you know the top 20 health insurance terminology, you can now comfortably navigate health insurance choices when it is time for open enrollment.

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