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Health Insurance Glossary For Beginners
A plain-language starter dictionary of common health insurance terms, from premium and deductible to network, claim and formulary, with simple examples.
Choosing Coverage
Insurance Vocabulary
Plain-language definitions of common insurance terms.
Allowed Amount And Usual And Customary Charges
Learn how health plans decide what counts as a reasonable charge, what allowed amount and usual and customary charges mean, and why bills and plan figures differ.
Copay Versus Coinsurance
Copay is a flat fee and coinsurance is a percentage share. See how copay and coinsurance differ, how they interact with deductibles, and hypothetical examples.
Covered Services Versus Exclusions
Learn how to find out what a health plan does not pay for, where coverage exclusions and limits appear in plan documents, and what to ask before you receive care.
EPO And POS Plans Explained
A plain-language look at EPO and POS health plans: how exclusive provider organizations and point-of-service plans handle networks, referrals and out-of-network care.
HMO Versus PPO Explained
Compare HMO versus PPO plans in plain language: how networks, referrals, out-of-network coverage and costs generally differ, and what to weigh when choosing.
In-Network Versus Out-Of-Network Care
See what changes in cost and coverage when you leave your plan's network: contracted rates, separate deductibles, balance bills, and how to check a provider first.
Referrals And Primary Care Gatekeepers
Find out when health plans require a referral to see a specialist, what a primary care gatekeeper does, and how to check the rules for your own plan.
What Is An Out-Of-Pocket Maximum
An out-of-pocket maximum caps what you pay for covered care in a plan year. Learn how it works, what typically counts toward it, and what does not, with an example.
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