8 health insurance terms you should know when looking for a plan | hioscar Blog | Oscar
8 health insurance terms you should know when looking for a plan
A helpful glossary of terms that you’ll probably be see when you shop for health insurance.
Picking a Plan Oscar Health Insurance
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Have you ever been scrolling through the details of a health insurance plan and suddenly you’re like, “Hold on a sec, I don’t know what any of these words mean!” You’re not alone. It can get confusing pretty quickly when strange new insurance terms are being thrown around left and right. At Oscar, we are all about keeping things simple, so we’ve compiled a mini-glossary of terms that you’ll probably be seeing when you shop for health insurance.
Open Enrollment (opens in new tab): The period every year when individuals and families can enroll in health insurance plans in the individual marketplace. This is an opportunity to switch plans, add family members, and apply for financial aid. In most states, Open Enrollment runs from November 1st to December 15th, but in California, Colorado and New York the deadline isn’t until January. You can get more details on deadlines in our post on the ins and outs of Open Enrollment (opens in new tab).
Premium (opens in new tab): The fixed monthly fee you pay your insurer to keep your health insurance plan. It’s important to pay your premium on time every month so you keep your coverage. Depending on your household income, you may qualify for an advance premium tax credit (opens in new tab) to help pay for your monthly premium costs.
Out-of-Pocket Max (opens in new tab): Your out-of-pocket max is the most you could pay for covered health care in a calendar year aside from your monthly premium. Out-of-pocket max amounts vary by plan, and are there to protect your finances from big medical bills.
Copay (opens in new tab): Fixed dollar amounts you’re responsible for paying for covered appointments, services, medical equipment, or prescriptions. Copays vary for the type of service received. For example, a copay for a doctor visit may be higher than a copay for a common generic prescription.
Coinsurance (opens in new tab): The amount you owe for covered health care services or prescriptions. Coinsurance is calculated as a percentage of the allowed service amount. So, if a service costs $100 and your coinsurance is 20%, you would owe $20, and your insurance company would pay the remaining $80.
Schedule of Benefits (opens in new tab): A document outlining the fees associated with each type of health care service covered by your plan that gives you a good idea of what things will cost up front. Deductibles, out-of-pocket max, copays, and coinsurance are listed in this document, as well as free preventative services (opens in new tab) and other common types of care.
Hopefully, our micro-dictionary has helped shine light on some confusing health insurance terms as you shop for plans. If you’d like more info on how to choose the right plan, where to get health insurance, insurance plan types and more, be sure to check out our detailed guide on choosing health insurance (opens in new tab).
