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Understanding Health Insurance Terms

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If you’re young and fortunate enough to be healthy, health insurance might seem like an afterthought. But the truth is, no one knows what the future brings, and not many people plan on getting in an accident or getting sick.

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If you’re young and fortunate enough to be healthy, health insurance might seem like an afterthought. But the truth is, no one knows what the future brings, and not many people plan on getting in an accident or getting sick.
Health insurance is an essential part of life that (should) protect you from experiencing a huge blow to your finances if you’re hospitalized unexpectedly. Plus, most plans provide free preventative care, including some check-ups, vaccines and screenings. Besides that, you’ll receive a fee when you’re filing your 2016 taxes if you weren’t covered this past year. For 2016, the fee is going to be $695 or 2.5 percent of your income, depending on which amount is higher.
Common Terms
Co-Pay: A co-pay is the amount you’ll need to pay towards an office visit or prescription medicine.
Deductible: Deductible is the amount of money you’ll need to pay toward covered medical expenses before your insurance starts covering part of the costs. This amount will reset after the end of the year, and you’ll need to meet your deductible again. Keep in mind you still might need to pay co-pays and other expenses that aren’t covered on your specific plan.
Premium: This amount will be what you’re paying monthly to have health insurance. If your employer offers healthcare, they may pay a part (or even all) of this premium for you.
In-network vs. Out-of-network: Your insurance provider will have a group of hospitals and doctors in their network. Choosing an out-of-network doctor means you’ll be paying a larger amount or even the total cost, depending on your plan.
What is the difference between an HMO, PPO and an EPO?
If you’re choosing a plan, you might hear these acronyms tossed around. Some may offer more flexibility while others may offer cheaper premiums. Understand the difference of each with your specific insurance provider, and choose what works best for you.
HMO (Health Maintenance Organization): Generally, you need to use a specific in-network doctor for coverage. It’s also common that you’ll need to see your primary care doctor for a referral before visiting a specialist, except in an emergency.
PPO (Preferred Provider Organization): This plan is usually more flexible with seeing an out-of-network provider and making an appointment directly with a specialist. Keep in mind that there still may be a network of doctors that will end up costing you less.
EPO (Exclusive Provider Organization): In general, you have a limited network of doctors and hospitals you can visit so costs are covered by your provider. The difference between an EPO and an HMO is that in most EPOs, you may not need a referral to see your in-network specialist.
Tips for Making the Most Out of Your Plan
New to health insurance? Here are a few tips:
Understand exactly what is covered and what isn’t. If you have questions, contact your insurance provider to help uncover anything that isn’t clear to you.
Use a physician in your network. Most insurance providers provide a searchable database on their website so you can find which doctors are in your network (if your plan works this way). Going to an out-of-network doctor could potentially cost you more, so double check what specifications are included in your plan.
Know what prescriptions are covered. If you need a prescription, see if it’s covered by your insurance. Some providers only cover specific types. If it isn’t covered, talk with your doctor about choosing a similar prescription or generic brand that is covered by your plan.
If you’re not sure if an upcoming doctor appointment or procedure is covered by your insurance, all you have to do is call to check.

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