Ways To Understand Health Insurance Jargon

While everyone knows about health insurance and that they need it in today’s expensive medical world, few people actually know the meanings of many of the different health insurance terms that are thrown about. To ensure that you are familiar with many of the terms that govern health insurance, here are the definitions of the main terms you need to know.

Premium – for many people, this is what your employer, or sponsor, will pay each month for your health insurance. Sometimes, individuals pay this amount to their employer or directly to the health insurance company. This, in turn, covers you under their insurance.

Deductible – this is what you will sometimes have to pay out of your pocket before the health insurance will take care of the remainder of your bills. Sometimes this is on a per person basis, sometimes it’s per family. Make sure that you know exactly what your deductible is so you aren’t blindsided with it.

Copayment: This is the amount that you have to pay at the time of service (such as doctor visits, hospital stays, etc), that comes out of your pocket before your health insurance will pay the remainder. This is normally a small amount, usually under $50.

Coinsurance: This is when you have two or more types of health insurance that will cover your visit. For example, many seniors will have Medicare as well as a private health insurance that will pick up the remainder of what Medicare does not pay so they will not have any out of pocket expenses.

Coverage Limits: There are some health insurance policies that will only pay for a specific set amount of different types of coverage. For example, they may only pay up to $1000 a year on basic physicals for your entire family. This is one area where you need to check your health insurance plan well so you aren’t caught with payments that you thought we covered.

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 – this basically means that you need to get approval from your health insurance or primary care provider to go and see a specialist, such as a Physical Therapist, an OB/GYN, or surgeons. This also helps to keep you in the network of their providers.

Capitation: This is the overall amount that your health insurance company will pay to your medical professional (i. E. Doctor, surgeon, dentist) to ensure that they will see anyone covered under their health insurance plan.

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 low income dental insurance at cheap prices and affordable dental insurance for seniors.