The Basics of Medical Insurance

What is medical insurance?

Medical insurance, or health insurance, helps to cover expenses due to illness, injury, and procedures.

We simplify the matter of health coverage by helping you focus on the aspects most important to you. With those aspects in mind, we help you choose the option that will best serve you and your loved ones while being as cost-effective as possible. We offer comprehensive, comparative health insurance quotes so that you can make an educated decision and get the health coverage you and your family need and deserve!

Common terminology

Premium. Similar to life insurance premiums, this is the amount you pay the insurance company in order to have coverage.
Deductible. The amount of money you need to pay out-of-pocket before your plan starts to pay.
Copayment (Copay). The amount you pay out-of-pocket after your deductible is met. This is usually a fixed amount and applies to doctor visits, prescriptions, and specialist visits. For example, your co-payment on a primary care physician visit may be $20. If your deductible has been met and you visit your primary care physician, you will need to pay the $20 copay.
Coinsurance. The percentage you pay out-of-pocket for services after your deductible is met. For example, your coinsurance may be 20% on a doctor’s visit. If the doctor’s visit costs $100 and you have already met your deductible, you will be responsible for paying $20 out-of-pocket, aka 20% of the cost.
Out-of-pocket Maximum. Don’t worry. Most plans have a maximum limit for out-of-pocket expenses. If you meet your deductible AND your out-of-pocket maximum, your plan will cover the remainder of all covered expenses for the rest of the plan year.
Network. A group of health care providers and facilities that are contracted together to provide care to its members. Providers in any given network are referred to as “network providers” and are “in-network”. Providers in another network are referred to as “out-of-network”.

Did you know? In 2018, 41% of under-insured adults said they had delayed care and 47% said they had trouble paying their medical bills. Among those with adequate health coverage, meanwhile, 23% said they had put off care, while 25% said they had problems with medical expenses.
U.S. News

Types of Plans

Health Maintenance Organization (HMO)

This plan usually limits you to seek care from in-network providers except for an emergency. Some HMO plans require you to live or work within a certain area to be eligible for coverage.

Preferred Provider Organization (PPO)

This plan allows you to utilize out-of-network providers without a referral from your primary care physician, but they are more expensive than in-network providers.

Point of Service (POS)

With this plan, you are able to utilize out-of-network providers for a lesser cost than PPO plans. However, you will need a referral from your primary care physician when seeing a specialist.

Exclusive Provider Organization (EPO)

Outside of an emergency, this plan will only cover in-network providers.