5 min read
Most confusion about health plans is vocabulary, not math. Here's the vocabulary.
The money words
These four describe everything you'll ever pay:
- Premium — the monthly cost, whether or not you use the plan.
- Deductible — what you pay before the plan starts sharing costs.
- Copay — a fixed fee per visit or prescription.
- Coinsurance — your percentage share after the deductible.
The access words
These describe where you can go and who decides:
- Network — the providers who've agreed to the plan's rates.
- In/out of network — whether a provider is on that list.
- Referral — permission from a primary doctor to see a specialist.
- Prior authorization — the carrier approving a treatment in advance.
The eligibility words
And these decide whether you can buy it at all:
- Underwriting — the carrier reviewing your health history.
- Guaranteed issue — acceptance regardless of health history.
- Open enrollment — the annual window for marketplace plans.
- Special enrollment period — a window opened by a life event.
General information only. Not insurance, tax or legal advice about your situation, and not a price offer.