Looking to learn more about health insurance terminology? In addition to reviewing the current SHIP health insurance premiums (the regular payments that keep your health insurance active) the following videos can help you better understand how insurance works. These videos are from the state-based insurance exchanges in Massachusetts, which, alongside with California, is one of the most robust state-based health insurance markets in the country.
Annual Deductible Explained
Deductible: the amount you pay “out-of-pocket” to your health care provider for covered services before your health plan kicks in to pay for ongoing treatment.
Maximum Out-of-Pocket Explained
The maximum amount that your combined health care will cost you (payments made toward the deductible, including copayments and coinsurance). After you hit this spending amount, the rest of your health care costs are taken over at 100% by your insurance company.
Copayments: “out of pocket” fees you pay to your health care provider for certain visits.
Co-Insurance Explained
Coinsurance: is the percentage of covered medical expenses that you pay. Your coinsurance plus the insurance company’s coinsurance are made to the health care provider.
Provider Networks Explained
Provider Network: group of physicians, hospitals, and other health care providers that have agreed to provide medical services at pre-negotiated rates with the insurance company. Note: in general, provider services “in network” (designated care providers or preferred care providers) are covered at the highest percentage.