Learning Center

What is a Deductible?

A deductible is the amount an enrollee must pay for covered medical services before an insurance plan will start covering costs. For instance, if your plan has a $1000 deductible, you must pay this amount towards covered healthcare expenses before your insurance will start paying for a share of costs. Some plans may provide cost-sharing on certain medical services, such as primary care visits, before a deductible is satisfied.

What is Co-Insurance?

An enrollee begins to pay for coinsurance after their deductible has been met. A coinsurance fee refers to a percentage of a healthcare cost that they will be charged. For instance, an in-network doctor's visit may have a 20% coinsurance rate. If the visit costs $100 total, the consumer will be responsible for paying $20, and the insurance company pays the remaining $80.

What is Co-Pay?

Co-Payment is similar to coinsurance, but instead of being figured as a percentage of a service's cost, it is calculated as a flat fee for a medical service. For instance, your plan may charge a $15 copay for visiting an in-network specialist. As with coinsurance, in many cases copayments will not begin until the consumer has met their deductible.

What is out of pocket max?

Your annual out-of-pocket limit is the maximum amount you pay for deductibles, coinsurance, and copayments within your coverage period. After this amount is reached, the plan pays 100% of covered medical services delivered in-network for the remainder of the year. Costs that do not have to be counted towards your out-of-pocket maximum include: premiums, out-of -network costs, and uncovered medical services.

What is Term Health Insurance?

Term Health Insurance is a health insurance product that covers doctor visits, hospitalizations, emergency care, lab tests, x-rays, and other common medical needs. Term Health Insurance is associated with low premiums and broad healthcare provider networks that accept the insurance. Applicants for Term Health Insurance have their health status evaluated as part of the process that determines whether the applicant is accepted or rejected. While application approval criteria vary among states and insurers offering Term Health Insurance, applicants with significant health problems (e.g. morbid obesity) or expensive pre-existing conditions (e.g. cancer) are not approved for coverage. Because Term Health Insurance has numerous differences from health insurance plans that operate under the Affordable Care Act (Obamacare), it's important to understand these differences.