It doesn’t matter who you are, you probably have, or have had, health insurance. And, chances are that you’ve also seen all of the medical and insurance jargon that is downright confusing to the majority of readers. But if you know what these terms mean, then you can easily get the right policy and coverage for you. So, here are eight of the most common, essential health insurance terms that you need to know:
Premium: This is the amount that you or your employer (or sponsor) has to pay every month for the health insurance to cover yourself or your family.
Deductible: This is the amount that you have to pay from your own pocket before the insurance will take care of their part.
Copayment – some health insurance plans have you pay a copayment, or part of the bill for that service. This is usually done before the health insurance will pay for the remainder of their services. Usually, this is pretty small, such as under $60.
Coinsurance – many people have this, especially seniors that are on Medicare. This just means that you have one main health insurance plan and then another, smaller plan (coinsurance) that covers the remainder of the bill. Many people that are on fixed incomes have coinsurance so that they aren’t stuck with massive unexpected expenses.
Coverage limits – some health insurance companies have set limits on what you can spend in a set year on medical care. Sometimes these limits go beyond this, and are lifetime limits. You want to make sure that you know what your limits are so you aren’t surprised.
In-Network – this is how your health insurance will determine which doctors you can see and which you can’t. When you sign up for your health insurance, they will give you a list of those medical providers that are considered “in-network” so that you can pick your doctor and not have to worry about your insurance covering them or not.
Prior Authorization – normally, health insurance companies will require that you have prior authorization either from them or from your primary care physician before you see a specialist. So, when you need to go to an OB/GYN or surgeon (or other specialized medical professional) you will need to check and see if you need to get a prior authorization to ensure that their services are covered.
Capitation – this is a term that many people aren’t familiar with. It basically is the amount that the health insurance company will pay a specific medical professional to ensure that they will see anyone that is covered under their health plan. This is how your health insurance comes up with their in-network lists.
While there are thousands of other health insurance terms that you should get to know, you should also take the time to read through your insurance plan so that you will be familiar with what is covered and what is not. There are so many different health insurance plans and different things that are covered and aren’t, so you need to be aware exactly what you have coverage for and what you might need in the future.
Dawn Enstruthe writes for website DS Health Insurance which info on topics like dental insurance for low income people and dental insurance for seniors.
