Health Insurance 101

Health Insurance is SO complicated. But this year, we decided to make it easier for you. Here’s some key terms and concepts as you navigate Open Enrollment.

Deductible – amount you pay out of pocket until coverage kicks in.

Out-of-pocket maximum – the most you could pay in a year for covered services.

Preventative care – typically covers annual health maintenance exam (physical), screenings, immunizations, etc.

Co-pay – paid in lieu of deductible for certain services.

EPO – exclusive provider organization – non-network providers are not covered (insurance will not pay) except for emergencies.

PPO - preferred provider organization - in-network providers are covered preferentially - often at a lower lower cost for you than out-of-network providers.

HMO - health maintenance organization - network of providers, like an EPO, but referrals are required from your primary care physician to see a specialist.

HDHP - high deductible health plan - health insurance plan where all expenses are out-of-pocket until you reach your deductible - no co-pays.

Coinsurance – percentage of medical bill you pay, after meeting deductible, and before hitting the out-of-pocket maximum.