Researching and understanding insurance plans can be difficult. What’s covered? What’s not? How much do you pay out of pocket? In order to better help you understand your insurance plan, we’ve put together a list of common terms that you might run into.
Claim: A detailed bill your doctor sends to your health insurance provider. This bill shows any care you receive.
Premium: This is the amount you pay every month to maintain your health insurance plan to stay covered.
Deductible: The amount you pay for covered care before the Insurance company starts to pay. Example-If your deductible is $2,000, you will pay the first $2,000 of the covered services yourself until insurance kicks in.
High-deductible health plans (HDHP): Under these plans, you’re expected to pay more of your health care bills, but your monthly payments for coverage will be cheaper.
Co-payment: A set fee you pay when visiting a doctor after you’ve met your deductible. You might have different co-payments for doctor visits, hospital stays and other types of care.
Coinsurance: Some insurance plans expect you to pay a percentage of the bill even after you’ve met your deductible. For example, you could be on the hook for 20% or 30% of the bill while the insurer handles the rest.
In-network provider: A medical professional that a plan has contracted with to provide medical care to its members. Staying in network means your insurance will cover more of the costs and your bills will be cheaper.
Out-of-network provider: A medical provider who does not have a contract with your health insurer, and will likely be more expensive to receive care from. You can end up being responsible for most, if not all of the bill if you go to an out-of-network doctor.
Out-of-pocket maximum: The most you have to pay for covered services in a plan year. While deductibles and coinsurance could mean you end up paying a lot of money for health care, there is a limit to what you’ll be responsible for paying.
Explanation of Benefits (EOB): While it may look like a bill, it isn’t. An EOB is just an overview of what (and how much) your doctor billed to your insurance company and what the insurer has agreed to cover. It can also include an estimate of how much you might be expected to pay, but the medical provider will send a bill separately.
As always, if you have any questions feel free to contact us.