Health Insurance Glossary

Here are some of the most common terms you will encounter when selecting and using health insurance:

Premium-the amount you and/or your employer pays for health insurance. It can be paid monthly, quarterly or yearly.

Deductible- the amount of money that must be paid out-of-pocket for a health care service before an insurer will start to pay

Co-payment- fixed amount you pay when receiving a health service, such as a doctor visit or to receive prescription drugs

Co-insurance-the percentage an insured person pays for a service after a deductible is met. Your insurance pays the rest.

Network-the hospitals, physicians and other health care providers your insurance has contracted with to provide health care services.

HMO (health maintenance organizations)-managed care plans that have a closed network of providers you can visit. Most HMOs require you to have a primary care physician who will refer you to a specialist if needed.

PPO (preferred provider organization) –­ managed care plans that allow you to visit any doctor from a preferred network of hospitals and physicians. Under PPOs, you can visit a doctor out-of-network, but you will be charged more.

Out-of-network—health care providers not contracted to provide services to customers on a particular health plan

Out-patient-a person who visits a hospital or clinic for medical services but does not require an overnight stay

Inpatient-a person who is admitted to a hospital for at least one night for ongoing care

Mental Health Care-the diagnosis and treatment of mental illnesses, such as depression

More Complete Lists of Health Insurance Terms

Resources reviewed June 2013

MORE PAY FOR YOUR HEALTH CARE RESOURCES
Getting Health Insurance
Advice for finding the right health insurance to fit your needs and budget, as well as information about health insurance reform.
Health Insurance: Glossary of Common Terms
Don’t know a deductible from a premium? Here’s a helpful guide to health insurance terms.
What Are Medicare and Medicaid?
Learn more about the U.S. government’s health insurance programs
How Much Will Your Health Care Cost?
It can be hard to figure out how much your health care will cost ahead of time. Here are some tips for preparing for the cost of your procedures and websites that can provide estimates for common procedures.
Paying for Prescription Medications
Prescription drugs can be expensive. Here’s how to get help paying for them and finding lower cost options.
Handling an Insurance Dispute
If you’re faced with an unexpected charge or your health insurance denies you coverage for a procedure or treatment, here are some steps you can take.
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RESOURCES

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