Know the lingo
To understand your health plan and how to use it, you first have to know the meanings of words commonly used in policies and benefit explanations.
Learning the lingo can feel like a whole new language, so these five terms can help get you started:
1. Coinsurance: Because you share costs with your health plan, your coinsurance represents the percentage of the bill that you have to pay for a covered health care service. If your health plan includes coinsurance for a particular health care service, you pay the coinsurance plus any deductibles you owe.
For Example: If the amount your health plan covers for an office visit is $100, and you've met your deductible, your coinsurance payment of 20 percent would be $20. The health plan then pays the rest of the allowed amount.
2. Deductible: The amount you could owe up-front before your health insurance or plan begins to pay.
For Example: If your deductible is $1,000, your plan won’t pay anything until you’ve paid $1,000 for covered health care services. Then, your plan will start paying for these services. This deductible may not apply to all services. If you need care often, a low-deductible plan may be more advantageous, but this may also cause you to have a higher premium.
3. Premium: The amount you must pay for your health insurance or plan, paid monthly, quarterly or yearly.
For Example: If you are enrolled in a medical plan, your monthly fee could be $20. This allows you to utilize the covered health care services.
4. Copayment: A fixed amount you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service.
For Example: After visiting a doctor to receive a routine check-up, the copay you have to pay could be $15.
5. Primary Care Provider (PCP): A person who provides, coordinates or helps you access a range of health care services as allowed under the state law and in the terms of the plan.
For Example: Physicians, including an M.D. (Medical Doctor) or D.O. (Doctor of Osteopathic Medicine), nurse practitioner, clinical nurse specialist or physician assistant.