Important Health Insurance Terms To Know
Health insurance is complicated; there is no doubt about that. While it is
difficult to absorb all the details of your health policy, there are a few terms
you should familiarize yourself with to make it easier to read and understand
your policy. These basic terms will help you to shop for and make sense of
your health coverage, so take a minute to learn and understand them.
Co-insurance And Copay
This is the amount you are expected to pay when you visit a doctor, go to
urgent care, or to the emergency room. These terms are often used
interchangeably, but they are a little different.
There are usually four different co-pay amounts for four separate types of
doctor visits. The lowest co-pay is generally the one you pay to visit your
regular doctor, pediatrician, or obstetrician. Often, a slightly higher co-pay is
charged for a visit to a specialist. This can include specialties such as
dermatology, ear, nose and throat (ENT) specialists, surgeons, and many
more. Finally, there are usually two set co-pay amounts for either an urgent
care or emergency room visit. Emergency room visits usually carry the
highest co-pay amount.
Co-insurance usually refers to a percentage of the total cost that you are
required to pay, especially for more unusual treatments and tests.
Much like your auto insurance, a health care deductible is the amount you
are expected to pay before your benefits kick in. Co-insurance amounts do
not usually count toward fulfilling your deductible requirements. In most
cases, regular office visits also won’t be charged toward your deductible.
Things like lab work, medical tests, and hospital visits are the types of costs
that will count toward your deductible. Once you have paid out the full
amount of the deductible, your policy will cover everything else at the set
If you have other family members on your policy, you may have two
deductible amounts—one per individual and one per family. Once the family
limit is met, no further deductible payments are required.
Out Of Pocket Limit
Most insurance policies carry a yearly out of pocket limit; this means that
there is a limited amount of money you will have to pay out of pocket in that
year. After this limit is reached for the year, insurance will cover the rest of
your medical care in full. This limit protects you in the event of a serious
illness or injury that results in a lot of medical bills.