10 Health Care Terms You Should Know Before Choosing a Plan

by Enrollment USA October 5, 2015


The health care world is a complicated one and if you’re dealing with it on your own for the first time, or even if you’ve dealt with it for years, it can be like speaking a foreign language. Below are some terms that you’ll need to know when researching a new plan to make sure you’re informed and getting the best plan match for your needs.

  1. Affordable Care Act: a health care reform law established in 2010. The law has two parts including the Patient Protection and the Affordable Care Act and is otherwise known as Obamacare.
  2. Benefits: all of the services included in your plan. Your provider should inform you of all the benefits provided by your plan.
  3. Claim: a request for payment. Typically your doctor’s office will submit the claim to the insurer, requesting payment for your visit. You can submit a claim yourself as well but will need a claim form and receipt from your doctor.
  4. Deductible: the amount you have to pay for covered services before the plan kicks in. Premiums and copays don’t count toward your deductible, so this is an important element to keep in mind when comparing plans.
  5. Copayment: a fixed amount that is paid for certain services. For example, when you visit your doctor, the copay may be $20 for every visit, while a trip to an eye specialist, might have a $40 copayment.
  6. Out-of-pocket: the amount of expenses that you will have to pay. Deductibles and copays are examples of out-of-pocket expenses.
  7. Premium: this is simply the amount you pay each month for your plan
  8. Preferred Provider: any companies, offices or vendors included in your chosen plan. The insurer usually contracts with these companies to offer negotiated rates. These providers are also considered “in network,” whereas organizations not included your plan are considered “out of network” and may have a higher copay rate.
  9. Subsidy/ Premium Tax Credit: assistance in the form of advance payment that can be used to lower monthly health plan premiums to make health insurance more affordable. To find out if you qualify, you may have to provide information about your income.
  10. Waiting Period: after signing up for a new insurance plan, this is the amount of time that you may have to wait before your new plan actually kicks in. This period of time usually starts with the policy’s effective date and may not pay benefits until that time.