Health Plan Terms

Preventative Care: Under the Affordable Care Act, most plans must cover preventative care at no cost to the patient, such as:

  • Yearly Physical
  • Anemia Screening
  • Cervical Cancer Screening
  • Here is the full listing: https://www.healthcare.gov/coverage/preventive-care-benefits/.

    Premiums: A fixed amount paid monthly by you and/or your employer to cover your health insurance.

    Co-pay: A fixed amount paid for a service. For instance, you might pay $20 copay for a doctor's visit.

    Deductible: The minimum amount you must pay your health provider will cover non-preventative care. If your deductible is high enough, i.e. $1,400 (ind) or $2,800 (Family), you qualify for a Health Savings Account(HSA) in 2020.

    Insurer Negotiated Rates: Insurers negotiate rates with providers that you will be responsible for paying. The average insurer discount is 30% (according to FAIR Health).

    Co-insurance: An insurer pays a portion of a claim, while you pay the remaining percentage. For instance, 10% coinsurance, on a service of $1000 is $100 out-of-pocket for the patient.

    Out-of-Pocket Maximum: The maximum amount out of pocket yearly, note this can drastically differ from your deductible, especially in a low-deductible plan. Deductible Included. The federal healthcare exchange maximums for 2020, i.e. $8,200 (Ind); $16,400 (Family.

    Health Savings Account (HSA): A health saving account (HSA) where you or your employer can deposit money tax-free (federal, not CA) and grow tax free (federal, not CA). Maximums $3,550 (Ind.) , $7,100 (Family). IRS Qualified Expenses: https://www.irs.gov/pub/irs-pdf/p502.pdf.

    Plan Year: A plan year is a set annual 12 month period in which you are covered under an insurance plan. Within a plan year, if you have a major life event, you can make changes within 30 days. Plan year might not follow calendar year.