Confused By Health Insurance Jargon? We’re Here To Help

posted by Alicia Caramenico

on October 4, 2017

Health insurance terms still confuse most Americans, CNBC. According to the report, a PolicyGenius survey of more than 2,000 health insurance consumers found only 4 percent could correctly define the terms deductible, co-pay, coinsurance, and out-of-pocket maximum.

“If you don’t understand how a deductible works, how coinsurance works … [when] you come in for a procedure or a lab test, those are the kinds of things that can result in a bill for $1,000 or $2,000,” PolicyGenius CEO and Co-founder Jennifer Fitzgerald said in CNBC.

In addition to a wide knowledge gap among consumers, the survey also revealed consumers aren’t confident in their ability to choose a plan that meets their health and financial needs. In the midst of Open Enrollment, a lack of comprehension and confidence can make it even harder for consumers to weigh their health insurance options and choose coverage for next year.

The world of health insurance can be confusing and overwhelming. But health plans know how important it is to provide patients with support in their health care decisions. The health insurance community is committed to providing resources that can help consumers understand their health coverage. One such resource is, developed by America’s Health Insurance Plans (AHIP) and National Consumers League (NCL). The interactive site is a go-to source for consumers to gain a better understanding of how their health benefits work, including common terms and phrases, and provides information on when and how to enroll in coverage.

The comprehensive glossary defines need-to-know health insurance terms, such as:

Cost sharing: The share of costs covered by your insurance that you pay out of your own pocket in addition to premiums, including deductibles, coinsurance, copayments, or similar charges.

Deductible: The amount you pay for covered health care services before your insurance plan starts to pay.

Formulary: A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Also called a drug list.

Out-of-Network Provider: A provider that has not contracted with your insurance company for reimbursement at a negotiated rate.

Whether consumers are buying insurance for the first time or they have questions about their existing plan, they can find helpful tips, checklists, and carefully vetted resources to get the most out of their health insurance benefits. We know that informed, educated, and engaged consumers will make the best decisions about their health care. And with, we’re working to make sure consumers can access the right information, in a clear, straightforward manner, so they move ahead with confidence as they choose and use their health insurance plan.

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