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Health Insurance Terms You Should Know When Looking for a Plan

Premium: 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 to help pay for your monthly premium costs.

Deductible: The dollar amount you have to pay out-of-pocket for covered services before your health insurance plan begins paying for your care. See How (and why) to switch individual health insurance for in-depth details on how deductibles work.

Out-of-Pocket Max: 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: 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 visit to the urgent care center could cost a $75 copay, while certain prescriptions may only cost you a $5 copay.

Coinsurance: 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.

Network: Your health insurance company has a network of doctors, hospitals, clinics, labs, and pharmacies that it works with. Your coverage often depends on whether a doctor or facility is in the network or not, so staying within your health insurance company’s network is the best way to save money.

Schedule of Benefits: 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 and other common types of care.

Open Enrollment: 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 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.

If you’d like more information on how to choose the right health insurance plan for you. Call Cosmo today at 732-363-3888 for a free quote.

Cosmo Insurance Agency is an independent insurance agency serving surrounding communities in New Jersey. Cosmo keeps its promise to assure an efficient and creative approach to the services we offer. Each of our clients experience a personalized and long-term relationship with us. Our New Jersey based team of health brokers guides our clients in helping them choose the most cost-effective options. By incorporating the latest in technology-based tools and laws on healthcare, employee benefits, life insurance and finance, we keep our clients up-to-date with the plans that encompass all of their needs, whether it is individual or group insurance.