Knowledge is power. This age old expression is just as true when you’re shopping for a health insurance plan. So we’ve put together a list of common healthcare terms that will give you the power to understand terminology as you search for the right plan. And also to help you take charge of your own health and medical expenses.
Allowed Amount – the maximum amount a health insurance plan will cover for a particular service. This may also be called “eligible expense,” “payment allowance,” or “negotiated rate.”
Benefit Period – usually annual, the benefit period is the time in which you are covered under your plan (see deductible below)
Copay – a dollar amount owed to your healthcare provider at the time of service. (this is for standard care only, and doesn’t always apply to diagnostic care) In many cases, you have to meet your deductible on your plan before the plan covers diagnostic services.
Deductible – the dollar amount you pay in medical expenses before your health insurance plan kicks in and begins to cover costs. Expenses you pay will accumulate towards your deductible during your benefit period. Once met, your plan will cover its’ predetermined amount until your benefit period ends, at which point deductibles generally reset.
Health Maintenance Organization (HMO) – A rigid in-network-plan that requires you to see specialists with prior approval from a primary physician.
In-Network – a healthcare provider who is in a contract agreement with the insurance company.
Medicaid – is a public health insurance program in the United States that provides health care coverage to low-income families or individuals. And certain individuals with disabilities.
Medicare – a program through the federal government that provides healthcare coverage for senior citizens.
Open Enrollment Period – the limited period of time wherein people are allowed to choose from health insurance plans on the ACA Marketplace. Finding a plan through Good Faith Health Insurance is not limited to an open enrollment period.
Out-Of-Network – healthcare providers who are not in a contractual agreement with the insurance company; benefits may not be covered, or covered at a lower level. In many cases, it also requires a referral from a primary-care-physician.
Out-Of-Pocket Maximum – The highest dollar amount you will have to pay in a given benefit period. (usually annual) After this amount is reached, plans pay 100% of costs for covered benefits. Services that are not covered under your plan and monthly premium payments do not apply to an out-of-pocket maximum.
Participating Provider Option (PPO) – a more flexible plan that allows you to see specialists without prior approval from a primary physician, and provides more flexibility in visiting providers out-of-network. You can read more about PPO’s and why this could be your best option in our blog here
Primary Care Physician (PCP) – A primary care physician is a physician who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions
Premium – the cost of your healthcare plan, generally broken down into monthly, quarterly, or annual payments to be made by you or your employer.
Referral – Authorization from a primary care physician for a patient to visit a specialist. Referrals are required for many healthcare plans, but not for PPO’s.
Specialist – A doctor who focuses solely on a particular branch of medicine
At Good Faith Health Insurance, we strive to help you make the best decision for your personal and financial well being. Hopefully you feel better prepared to dive into the search for your healthcare plan. If you need help in navigating this maze-like-industry, please reach out to us today!
