Health Insurance 101

Health care reform has made many people give more thought to the topic of health insurance. Understanding some basic health insurance terms can make navigating this arena easier.

Here are some common terms you might come across when trying to analyze which is the best healthcare insurance plan for you.

Co-Payment: Often called a “co-pay”, is the fixed amount you pay for a service.  For example, a $25 co-pay to see a doctor. Co-pays can vary based on whether you see your primary care doctor or a specialist. These are usually paid at the time of service.

Deductible: The amount you must pay before your health insurance begins to pay.  Not all care is subject to a deductible… for example, a physician visit may only require a co-payment. Your deductible can vary greatly- from $1,000/year to $10,000/year and can be for you alone or a family deductible. Adjusting your deductible can have a big impact on your premium because you’re assuming a much greater risk each year.

Think about a deductible on your home or auto insurance- if you file a claim, you will most likely need to pay a deductible and then the insurance company pays anything higher. The difference is a home or auto claim is usually one event or accident, whereas some people have multiple trips to a doctor or various procedures done before hitting their full deductible.

PCP: Primary Care Physician

Co-Insurance: After a deductible has been met, there may be a portion of costs to be covered. Unlike your home or auto policies that likely pay everything OVER your deductible, that may not be the case with your health insurance.  For example, an 80% co-insurance plan means that the insurance company pays 80% after the deductible has been met.  You will pay 20% of the costs. Co-Insurance continues until you reach your out of pocket maximum.

Out-of-Pocket Maximum: The maximum amount you can expect to pay in a given calendar year for medical expenses. Again, this can vary greatly.

So what can I expect to pay out of pocket?

  1. You may pay a co-pay.
  2. Then you may pay for any expenses until you reach your deductible.
  3. Then you will pay your co-insurance percentage of any bills after your deductible up until you reach your out-of-pocket maximum.

That’s a lot of terminology & can get awfully confusing really quick! If you have questions about your health insurance options, I recommend you call Jennifer Goedken at (480) 773-2068 for a conversation on your specific situation. I have worked with her for years and have come to trust her completely. Not only does she help my husband and I with our insurance needs on a regular basis, but she is the happiest and most knowledgable gal. Call or email Jennifer with more questions!

Jennifer Goedken Health Insurance agent

Benefits Gallery, LLC
Licensed Health & Life Insurance Broker
Phone: (480) 773-2068
Fax: (480) 347-0801
2524 S. El Paradiso Dr., #113
Mesa, AZ 85202

Jennifer Goedken is a licensed health insurance agent, in the state of Arizona, license #: 921010.  This information is not intended to be legal advice, or a complete instruction on any one topic regarding health insurance.