How to Choose a Health Insurance Plan

Premium:

The price you have to pay each month for your insurance plan.

Deductible:

A fixed amount a member must pay during a given time period, usually a year, before their health insurance benefits begin to cover the costs.

Copay:

A fixed amount paid by a member for receiving a particular health care service, with the remaining balance usually covered by the person’s insurance company.

Coinsurance:

The percentage of costs of a covered health care service you pay, usually after you’ve paid your deductible.

In-network:

When a doctor, hospital, or other provider accepts your health insurance plan, we say they’re in-network. We also call them participating providers.

Out-of-network:

When you go to a doctor or provider who doesn’t take your plan, we say they’re out-of-network.

HMO:

Stands for health maintenance organization. These are health plans that offer care through a network of doctors, hospitals, and other facilities and may require you to get a referral from your primary care provider (PCP) for certain specialty services.

PPO:

Stands for preferred provider organization. These are health plans that offer the flexibility to see in-network and out-of-network doctors.