#1
What is a deductible in health insurance?
The amount of money you pay out of pocket for covered services before your insurance starts paying.
ExplanationOut-of-pocket payment before insurance coverage.
#2
What is a copayment (copay) in health insurance?
A fixed amount you pay for a covered healthcare service, usually when you receive the service.
ExplanationFixed fee for covered service.
#3
What is a pre-existing condition in health insurance?
A condition that existed before you applied for or enrolled in a new health insurance plan.
ExplanationExisting health condition prior to insurance enrollment.
#4
What is Medicaid?
A federal health insurance program for low-income individuals and families.
ExplanationFederal insurance for low-income individuals.
#5
What is a provider network in health insurance?
A group of healthcare providers and facilities that have contracted with your insurance company to provide services at a discounted rate.
ExplanationDiscounted healthcare provider group.
#6
What is a formulary in health insurance?
A list of prescription drugs covered by a health insurance plan.
ExplanationList of covered prescription drugs.
#7
What is coinsurance in health insurance?
The percentage of costs of a covered healthcare service you pay (20%, for example) after you've paid your deductible.
ExplanationPercentage of covered service costs after deductible.
#8
What is an Explanation of Benefits (EOB) statement in health insurance?
A notice from your insurance company that lists what they paid and what you must pay for medical care you received.
ExplanationSummary of payments and charges for medical care.
#9
What is a health insurance network?
A group of healthcare providers and facilities that have contracted with your insurance company to provide services at a discounted rate.
ExplanationGroup of discounted healthcare providers.
#10
What is an out-of-pocket maximum in health insurance?
The maximum amount of money you can pay for covered services in a year.
ExplanationMaximum yearly out-of-pocket expenses.
#11
What is a health savings account (HSA)?
A type of savings account that allows you to set aside money on a pre-tax basis to pay for qualified medical expenses.
ExplanationPre-tax savings for medical expenses.
#12
What is a health maintenance organization (HMO)?
A type of health insurance plan that combines features of HMOs and PPOs.
ExplanationIntegrated health plan model.
#13
What is a health insurance premium?
The monthly payment you make to your insurance company for your coverage.
ExplanationMonthly insurance payment.
#14
What is Medicare?
A federal health insurance program for people age 65 or older.
ExplanationFederal insurance for seniors.
#15
What is an insurance premium tax credit?
A refundable tax credit designed to help eligible individuals and families with low or moderate income afford health insurance coverage purchased through the Health Insurance Marketplace.
ExplanationTax credit for low/moderate income health insurance buyers.
#16
What is a Health Insurance Marketplace (Exchange)?
A federal website where individuals and small businesses can shop for and buy health insurance plans.
ExplanationFederal platform for health insurance purchase.
#17
What is a lifetime maximum in health insurance?
The total amount your insurance company pays for your medical bills over the course of your lifetime.
ExplanationMaximum lifetime insurance payout.