A Guide to the Terms You Need to Know to Enroll
Enrolling in a health insurance plan is a big decision. Understanding a few key terms can help you feel confident during the enrollment process.
What is health insurance?
Health insurance helps you pay for health care costs. When you sign up for health insurance, you agree to pay a monthly fee called a premium. In exchange, your insurance company is required to pay some or all of your health care costs. This protects you from the high costs of health care when you go to the doctor or hospital.
The Costs
- The premium is a monthly cost you pay for your coverage.
- The deductible is the amount you owe for covered health care services before your health plan starts to pay. For instance, if your plan has a deductible of $1,000, then you have to pay $1,000 of your own money before the plan will start covering your costs. The plan pays for some services at 100% with no deductible.
- After reaching the deductible, you might pay a copay for health care services. A copay is a fixed amount ($20, for example) you pay for a covered health care service after you’ve paid your deductible. Most of the time, you make the payment when you receive the service.
- Instead of a copay, you might pay coinsurance. Coinsurance is the percentage of costs of a covered health care service you pay (20%, for example) after you’ve paid your deductible. For instance, if the health plan’s allowed amount for an office visit is $100 and you’ve met your deductible, a coinsurance of 20% means you pay $20. The health insurance or plan pays the rest of the allowed amount. Most of the time, you will be billed for this amount after you receive the service.
- Quick tip: Save money to pay for your deductible so you’re ready for anything. You might consider opening a health savings account (HSA) if you have a high-deductible health plan.
- Health insurance plans have an out-of-pocket limit for each person and family. Once you reach the out-of-pocket limit, the plan pays for all covered services.
- Quick tip: Choose a health plan with an out-of-pocket limit you’re comfortable with in case you have a major medical event.
The Benefits
Every health plan offered on the BeWell Marketplace covers a set of essential health benefits. These include things like hospital visits and preventative care. View the full list of essential health benefits.
- Some plans have a network of doctors and facilities. You might pay higher costs if you see providers who are out of network.
- Quick tip: Check to see if your doctor is included in the plan’s network of providers before you enroll.
Browse Our Glossary of Health Insurance Terms
This glossary provides general information. It defines medical terms you may see. It’s not a complete list. Your health plan may define these terms in your plan documents. Look at your plan documents for details. Not sure where to look? Check your Summary of Benefits and Coverage to find out how to get a copy of your policy or plan document.
