Health insurance can feel like a maze of confusing terms and fine print. Copays, deductibles, networks–what does it all mean? Understanding the basics can help you make smarter decisions about your healthcare. Here’s a quick rundown of key terms you need to know.
Benefit Period
The stretch of time your plan covers services–usually a calendar year. Your benefit period might reset annually or on the anniversary of when you first got coverage.
Coinsurance
Once you hit your deductible, this is the percentage of medical costs you’re still responsible for. Example: If your plan covers 85%, you’ll cover the remaining 15%.
Copayment (Copay)
A flat fee you pay at the doctor’s office or pharmacy when you receive care. Some plans skip copays altogether.
Deductible
The amount you pay for covered healthcare services before your insurance kicks in. Many plans have a $2,000 per-person deductible that resets each year.
HMO (Health Maintenance Organization)
An insurance plan that requires you to see in-network doctors and often needs referrals from a primary care provider to see a specialist.
HSA (Health Savings Account)
A tax-free savings account for medical expenses. You can set aside pre-tax dollars up to a yearly limit to cover healthcare costs.
Long-Term Care Insurance
A specific plan that helps pay for nursing home care, assisted living, or in-home medical services.
Network Provider
A doctor, hospital, or healthcare provider that has an agreement with your insurance company. Using in-network providers usually means lower costs.
Non-Network Provider
A provider who doesn’t have a contract with your insurance. Seeing an out-of-network provider usually means higher out-of-pocket costs.
PPO (Preferred Provider Organization)
A plan that offers strong coverage for in-network care but still provides some coverage for out-of-network services–usually at a higher cost.
Health insurance doesn’t have to be a mystery. Knowing these terms helps you navigate your plan with confidence and avoid surprise expenses.
