Health Insurance Terms in Florida

Here are some of the most important Health Insurance Terms Florida you’ll encounter, explained simply:

• Premium: This is the amount you pay each month (usually) for your health insurance coverage. Think of it like a monthly membership fee.
• Deductible: This is the amount you must pay out-of-pocket for covered healthcare services before your insurance plan starts to pay. For example, if you have a $2,000 deductible, you pay the first $2,000 of covered costs yourself each plan year.
• Copayment (Copay): This is a fixed amount ($20, $40, etc.) you pay for a covered healthcare service after you’ve met your deductible (for some services). You might have different copays for doctor visits, specialist visits, or prescriptions.
• Coinsurance: This is your share of the costs of a covered healthcare service, calculated as a percentage (like 20%) of the allowed amount for the service after you’ve met your deductible. If your coinsurance is 20% and the covered cost is $100, you pay $20.
• Out-of-Pocket Maximum: This is the most you will have to pay for covered healthcare services in a plan year through deductibles, copayments, and coinsurance. Once you hit this maximum, your insurance plan pays 100% of the allowed amount for covered services for the rest of the year.
• Network: This refers to the doctors, hospitals, pharmacies, and other healthcare providers that an insurance plan contracts with. Visiting providers in-network costs you less than visiting providers out-of-network (or may not be covered at all).
• Open Enrollment Period: This is a specific time each year when individuals can enroll in, change, or re-enroll in a health insurance plan through the Health Insurance Marketplace. Enrollment outside this period is only possible with a Special Enrollment Period.
• Special Enrollment Period: A time outside of Open Enrollment when you can sign up for health coverage due to a qualifying life event, such as losing other coverage, getting married, or having a baby.
• Allowed Amount: The maximum amount a plan will pay for a covered healthcare service. If a provider charges more than the allowed amount, the difference may be billed to you.
• Pre-existing Condition: A health problem you had before the date your new health coverage starts. Thanks to the Affordable Care Act (ACA), Marketplace plans cannot deny you coverage or charge you more based on a pre-existing condition.