Understanding Health Insurance Lingo
The 411 on health care's basic vocabulary.
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Why You Need to Know These Terms - With the Health Insurance Market opening on Oct. 1, it is crucial for you to be savvy about health care terms. But where do you start? And what exactly do you need to know? Read this glossary on health care basics and why they matter to you and your family. —Kellee Terrell (Photo: Comstock/Getty Images)
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Co-pays - A fixed amount of money you pay every time you go to the doctor. For example maybe your co-pay is $20, but that price varies and depends on your insurance. Make sure to keep this in mind when shopping for health insurance plans. (Photo: Comstock/Getty Images)
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Deductibles - Deductibles are the amount of money you have to spend before your insurance kicks in and begins paying for care. So if your deductible is $500, you have to pay $500 for services in that year before health care starts shelling out money. It’s important to know that not all services go toward your deductible, so make sure you check what is included in this fee. (Photo: BSIP/UIG Via Getty Images)
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Co-insurance - Co-insurance is the health-care cost sharing between you and your insurance company — that number ranges from 80/20 or 50/50. If you have an 80/20 arrangement, your health care company would pay for 80 percent of all medical costs that year, while you pay 20 percent. But the cost-sharing stops when you meet your out-of-pocket max, which is usually between $1,000-$5,000. (Photo: Comstock/Getty Images)
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Premiums - A premium is what you pay every month to the insurance company for your health care. This is the first thing you should consider when shopping for health insurance. You have to make a budget to make sure you can afford this fee every month. How much you pay depends on an array of factors: age, gender and which type of plan you enroll in. (Photo: Rolf Bruderer/Getty Images)
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Subsidized Plans - Subsidized plans help low-income and middle-income families afford health care by the help of government. The government pays for a part of these plans, making them cheaper for you. These types of plans are really good for young people who have jobs, but don’t make a lot of money. (Photo: Tetra Images/Getty Images)
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Benefits - Benefits are what your health insurance covers under your plan. Each plan will offer “essential health benefits” which include some of the following: maternity and newborn care, mental health services, emergency care, lab tests and ambulance rides. Also, preventive care and preventive screenings under the Affordable Care Act are free and co-pay free. (Photo: Joe Raedle/Getty Images)
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Medicaid - Medicaid is a government-issued insurance for low-income and disabled Americans. Prior to the Affordable Care Act, you couldn’t qualify for Medicaid if you were not pregnant, not disabled Americans or didn’t have children. But that has changed with the new Medicaid expansion. Check here to see if your state has accepted the Medicaid expansion. (Photo: Joe Raedle/Getty Images)
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Medicare - Medicare is government insurance for Americans 65 and older. Tell your loved ones who have Medicare that they don’t have to worry about the health insurance marketplace — their plans don’t change. (Photo: David McNew/Getty Images)