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Health Insurance Terms in Plain English
Ten common words. Ten short answers. No alphabet soup.
Premium
The amount you pay to keep your health insurance active. It is usually billed every month.
Deductible
The amount you pay first for certain covered services before the plan begins paying its share.
Copay
A fixed dollar amount you pay for a specific service, such as a doctor visit or prescription.
Coinsurance
The percentage of a covered bill you pay after the deductible applies.
Out-of-pocket maximum
The most you pay during the plan year for covered care that counts toward this limit. Premiums do not count.
Network
The doctors, hospitals, pharmacies, and other providers that have agreed to work with the insurance plan.
Marketplace
The federal or state service where people can shop for ACA health plans and find out whether financial help is available.
Tax credit
Financial help that can lower the monthly price of a Marketplace plan for people who qualify.
Open Enrollment
The yearly period when people can enroll in or change an individual health insurance plan.
Special Enrollment Period
A limited opportunity to enroll outside Open Enrollment after certain life events, such as losing qualifying coverage.
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