Basics of Health Insurance

How Is Health Insurance Priced?

Your price for health insurance is based on a few factors, including your age, zip code, the type of plan you select, and at times income. Depending on your situation, you may qualify for special programs to lower your monthly payments and out-of-pocket expenses.

What are Co-payments and Co-insurance? 

A copay is a set rate you pay for prescriptions, doctor visits, and other types of care. Co-insurance is the percentage of costs you pay after you've met your deductible.

What is a Deductible?

In an insurance policy, the deductible is the amount paid out of pocket by the policyholder before an insurance provider will pay any expenses.

What does the Out-of-pocket maximum mean?

The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance for in-network care and services, your health plan pays 100% of the costs of covered benefits. The out-of-pocket limit doesn't include Your monthly.

What is a Premium?  

A premium is the amount of money your insurance company charges for your chosen plan. It is usually paid monthly but can be billed in several ways. You must pay your premium to keep your coverage active, regardless of whether you use it or not.

What is a PPO?

Preferred Providers Organization, referred to at times as Preferred Providers Option is a health plan that contracts with doctors and hospitals to create a network of participating providers. You pay less if you use the providers that belong to the network. You have the flexibility to go outside of the provider’s network.

What is an HMO?

Health Maintenance Organizations have their own network of doctors, hospitals, and other healthcare providers who have agreed to accept payment at a certain level for any services they provide. Typically this only provides localized coverage and restricts services out of state and outside of the service area. You will need a referral from your PCP for any specialist visits.