This is the amount of money that is paid to the health insurance company.  It is usually paid for by you or your employer monthly, quarterly, or yearly.

This is a broad term that refers to cost you need to pay out of your own pocket as they are not covered by your insurance company.  Common cost sharing methods are deductibles, coypayments, and coinsurance.

Cost sharing does not usually include cost such as premiums, the cost of non-covered services, or out-of-network cost.

This is a flat dollar amount that needs to be met before your health insurance will begin to pay.  For example, if your health insurance plan has a $1000 deductible, you will be required to pay the first $1000 upfront.  After the deductible has been met, the health insurance company will begin to pay it’s share.

Not every service has a deductible and some services may be included with coverage at no cost to you.

Coinsurance is shown as a percentage (such as 20%) and refers to the portion of cost that you are required to pay after you have met your deductible.

For example, if you have a service that cost $2000 and have a deductible of $1000 and a coinsurance of 20%, assuming you have not met any of your deductible yet, you would be responsible for the first $1000 upfront.  After that, you would pay 20% of the remaining $1000, for a total of $1,200 for the service.

As with most things, there are exceptions to this.

This is represented as a flat dollar amount and refers to the your portion of cost for a service.  This amount can vary depending on the service.

This is the most amount of money that you will spend in a policy period (usually a calendar year) before your health insurance will pay for 100% up to the allowed limit.  The max out-of-pocket (MOOP) does not include premiums and usually does not include cost for services not covered by your health insurance.  Some insurance plans do not include your shared cost or out of network cost either.

The is the maximum amount of money the insurance company will pay towards your health care in a given policy period.

Networks refer to all of the hospitals, doctors, and suppliers that the insurance company has contracted with and negotiated the prices for services.

Networks are broken down into two categories, In-Network and Out-of-Network.  Your insurance policy will have different coypayments, coinsurance, and sometimes different deductibles for non-preferred providers and the amount that you spend out of network sometimes does not count towards your MOOP.

There are a few types of networks, but the most common are the HMO and the PPO.

HMO stands for Health Maintenance Organization.  This is a network based around a group of doctors that have contracted with the insurance company.  HMO networks are often based around a regional hospital, generally will not cover out-of-network care except in emergency situations, and require that you live or work in the service area to be eligible for the plan.  Most HMOs focus on prevention and wellness.

With plans that utilize an HMO network, you can usually expect lower monthly premiums and lower out of pocket cost in exchange for more restrictions on which doctors you can.  You will often times also need referrals for specialist.

PPO stands for Preferred Provider Organization.  A PPO network is much larger than a HMO.  While the monthly premiums and out of pocket cost are typically higher with a PPO than they are with an HMO, in exchange you have more freedom on which doctors you can see without needing to worry about out-of-network charges and often times not needing referrals to see specialist.

A provider is any doctor, physician, medical facility, or medical professional that has been certified as required by state law.

A pre-existing condition is any condition that you were diagnosed with before date your new health insurance starts.

Under the ACA, with very few exceptions, health insurance companies can not deny you coverage or charge you more because of pre-existing conditions.  They also cannot limit benefits for those conditions either.

These are health plans that have very low monthly premiums but also have very high deductibles.  They offer an affordable way to protect yourself from the worse-case scenarios such as getting seriously injured or sick.

With a few exceptions, these plans are only available for people under the age of 30.

This is a type of savings account that lets you put aside money in order to pay for certain medical cost.  The money can be put into this account before taxes.

Not all health insurance plans are HSA eligible.

This is the maximum amount of money the health insurance company will pay for a type of service.  If your provider charges more than your plan’s allowed amount, you may need to pay the difference.

This is a list of all types of prescription drugs covered by an insurance plan.  They are sometimes called drug list.

There are sometimes different tiers to a formulary, and depending on which tier a prescription falls, you will pay a different amount.  If a prescription is not on a formulary, it is not covered, though there are most often alternatives proven to be just as safe and effective at a lower cost.

The drug list do change and are very rarely the same between health insurance companies.

This is any health care service that your health insurance plan does not pay for or cover.  With excluded services, you will generally pay 100% of the cost.

A primary care provider (PCP) is the person who helps to coordinate all of your health care services.  They can be doctors, physician assistants, or clinical nurses, and are the main health care provider in non-emergency situations.

This refers to services that are needed to prevent, diagnose, or treat a problem.  Usually, if a service is not considered medically necessary, the procedure will be an excluded service and the health plan will not pay the cost for the service.

The Affordable Care Act (sometimes known as ACA, PPACA, or ‘Obamacare’) is a health care reform law.  The law has three primary goals; make affordable health insurance available to more people, expand Medicaid, and help to lower the overall cost of health care.

Some of the biggest changes brought on by the ACA are guaranteed coverage for pre-existing conditions, requirements that enforce all insurance plans carry a minimum level of health benefits, covering preventive services, and offering subsidies and cost-sharing reductions based on income, making insurance coverage more affordable for some individuals and families.

The Health Insurance Marketplace is a health insurance exchange website where people can browse plans and purchase health insurance that complies with the rules and requirements of the ACA.

Multiple companies have different types of plans available to meet a variety of needs.  There are restrictions as to when you can join a plan offered on the marketplace and when you can change between plans.

There are 4 categories of marketplace plans, each with different cost-sharing amounts and monthly premiums.  Additionally, regardless of the level of plan you chose, you can save an amount money on your monthly premiums based on your annual income.  Catastrophic plans are also available through the marketplace.