Navigating healthcare can be difficult. With so many moving parts, it can be tough to know how each part affects the others. Here are the some of the healthcare terms you should know and how they relate to one another.
A request for your insurance provider to pay for a product or service. Claims can either be sent by you or your healthcare provider.
Commonly called a "copay." This is a flat fee you're required to pay each time you receive a healthcare-related product or service. This can include visits to the doctor, prescription medications, and lab work. Copays can vary depending on who your insurer is and what kind of product or service you're getting.
The set dollar amount you must pay each year before your insurance begins to cover the remainder of your expenses. For example, if your deductible is $1,000, you'll have to pay $1,000 worth of healthcare services on your own. Once you reach the deductible, you'll typically only need to take care of your copays from that point forward.
Anyone who is covered by a given health-insurance plan other than the policyholder. For example, if you have health insurance through your employer, you are the policyholder. Anyone else who is covered by your insurance policy (such as a spouse or child) is a dependent. Usually, a child may remain on their parent's health-insurance policy until the age of 26, assuming the insurance policy allows for dependents.
A savings account that allows you to set money aside to pay for healthcare expenses. The advantage to an HSA is that funds can be deposited into the account pre-tax. HSAs can only be used with a high-deductible plan to help offset the costs. There may be penalties for using these funds for non-medical costs.
A group of healthcare providers that have contracted with your health insurer to provide services. Going outside of your network for services may leave you responsible for the entirety of the bill, so make sure all of your providers are within your network before making a trip to the doctor.
The amount you pay each month to maintain your health insurance coverage.
Note: Plans with a high deductible usually feature a lower premium while plans with a higher premium feature lower deductibles.