Like a good friend, your insurance policy is there when something goes wrong. And it’ll be a much better relationship if you speak the same language. We Skimm’d the terms you need to pick the right policies – and understand what they cover. Your wallet can thank us later.
Affordable Care Act: Aka Obamacare — a big bill with big drama. The 2010 law expanded Medicaid, made (almost) everyone get insurance, and told insurers they have to cover people with pre-existing conditions.
Beneficiary: Who you say should inherit your money and stuff after you’re gone. Deciding now – and updating whenever something major happens, like getting married or having a baby – can avoid confusion and post-funeral fights. Eenie, meenie, mo’ money for them.
Claim: An official request for your insurance company to do what you pay them to do. As in, help you pay for a covered expense.
Coinsurance: When you and your insurance company go Dutch on healthcare costs. It’s the percentage you pay for a covered service after you hit your deductible.
Copay: Short for copayment and kinda like coinsurance. But instead of paying a percentage of a bill, it’s a fixed amount you may pay every time you hit up the doctor’s office or pharmacy.
Deductible: How much you have to cough up for medical expenses before your insurance kicks in to help you out. Not-so-fun fact: it resets once a year.
Exclusions: Anything your policy doesn’t cover. Read the fine print to make sure you know what’s what.
FSA: Stands for flexible spending account. The kind you fill with pre-tax dollars from your paycheck for certain medical expenses. There’s a list. It includes things like medicine, glasses, and even Band-Aids.
High-Deductible Health Plan (HDHP): Creative name for insurance with a high deductible but low premiums. You’ll pay less each month, but maybe a lot more if you get sick.
HMO: An insurance plan with a special network (or Health Maintenance Org) of hospitals, clinics, and docs that agree to accept certain rates. That makes you pick one physician to be your go-to. More rules, usually lower costs.
HSA: An investment account you fill with pre-tax money for future medical expenses. Pros: whatever you don’t spend in one year can roll over to the next. Cons: you must have a high-deductible health plan, and there are penalties for using it to pay for the wrong thing.
In Network: A group of docs and hospitals that have made it official with your insurance company. As in, they’ve agreed to work with each other and probably negotiated lower rates. Because paying less is the best medicine.
Open Enrollment: The most wonderful (and only) time of the year to sign up for or change your health insurance...unless you’re just married, just babied, or just lost other coverage.
Out of Network: Out of mind. These are the docs, clinics, and hospitals your insurer has not explicitly decided to do business with. Use them, and you might have to pay the whole bill yourself.
Out-Of-Pocket Max: The most you could pay for covered medical expenses in a year. Your insurer will pick up the tab for the rest. Thanks, health insurance.
Premium: The monthly fee you pay for insurance. Because an apple a day doesn’t always work.
PPO: A health insurance plan with a big network (or Preferred Provider Org). You don’t need to ask permission from your doc to see a specialist. But you’ll probably pay more for that perk.
Single-Payer Healthcare: When the gov becomes everyone's insurer. Tends to make healthcare cheaper, but taxes higher. 2020 candidates like Bernie Sanders and Elizabeth Warren are here for it.
Underwriting: A fun game of ‘what are the odds?’ insurance pros play to decide a fair price for your premiums. Hint: the fewer issues you’ve had in the past (medical, credit, driving, etc.), the less you’ll probably pay.
Picking an insurance plan without understanding the policy is like choosing a restaurant without looking at the dinner menu. Read the fine print so that you aren't shocked when you get the bill.