Key terms and definitions for registering


Throughout my life, I have been fortunate enough to stay on my parents’ Medicare plan. But this year, I turned 26. So when my company launched its open registration period, the window where you choose your plans, it was time for me to spread my wings.

Clicking on the link to choose a plan seemed intimidating to me and it got worse when I started going through the selection process. What is an HSA? Or an FSA? Did I need this?

And what did a high deductible mean versus a low deductible in terms of the plan?

Overwhelmed, I decided to speak to the experts for help. One piece of advice they gave me is to learn the enrollment language before you start researching your healthcare plan. So here is a glossary of terms from USA TODAY with additional resources to help you on your insurance selection journey.

â–º Health insurance:Signing up for my first health plans seemed intimidating to me, so I got this expert review on open enrollment.

Glossary of terms to know when choosing a mutual insurance company

Premium: The premium is the amount you pay for health insurance on a monthly basis, according to HealthCare.gov.

This is the basic expense and generally does not cover other health expenses. Premiums vary by plan. A lower premium means a higher deductible and vice versa.

Deductible: A deductible is the amount you pay in expenses before their health insurance plan pays in full.

So, for example, if I were to sign up for a low deductible $ 1,000 health plan with a high monthly premium of $ 220, I would pay all of my health care costs until I hit 1. $ 000 in expenses. If my deductible was higher, say about $ 3,000 and my monthly premium was lower, say about $ 100 per month, I would pay until I hit $ 3,000 in medical expenses for the year.

Once a deductible is hit, insurance would bear the majority of the costs.

Co-payment: A co-payment is what is paid at the office of the health care provider. This is a “set amount ($ 20, for example) that you pay for a covered health service after you pay your deductible,” according to HealthCare.gov.

Authorized amount: Before you reach your deductible, the cost of the visit is the “maximum amount a plan will pay for a covered health care service” that you will pay under their health care plan, according to HealthCare.gov. The agency gave the example that if a person has not reached their deductible, they can pay $ 100 for a covered service that is less than the authorized amount compared to a co-payment of $ 20.

Health Savings Account or HSA: Open enrollment gives employees the option of contributing to what’s known as an HSA if they choose a high-deductible health plan (or a health plan with a lower premium per month), giving them the option to save money to spend on tax-free health care expenses.

According to HealthCare.gov, an HSA is “a type of savings account that lets you set money aside before tax to pay for eligible medical expenses.”

Dollars not taxed in an HSA can be used to pay for things like deductibles, copayments, and other health care expenses and can help lower overall health care costs. Typically, these funds in the HSA cannot be used to pay premiums.

Flexible Spending Account or FSA: An FSA is similar to an HSA in that the user can pay for medical expenses such as copayments, prescription drugs, medical devices, and insulin, among others with pre-tax dollars.

According to HealthCare.gov, if they are not spent by the end of the year, employers will give users two options: two and a half more months to use the funds in the account or to carry over $ 500 to the year. next.

On-grid or off-grid: If a health care provider is “networked”, that physician or facility is part of the network of a health care plan. Typically, networked providers cost less to the insured than off-grid providers that exist outside the insurer’s network because these networked providers have contracts with the insurer.

Specialist: Not all doctors are covered in the same way by insurance plans, specialists often cost more to do with a certain percentage covered by insurers. According to HealthCare.gov, a specialist is a physician who “focuses on a specific area of ​​medicine or on a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions.”

There are also non-medical specialists who have more training in a certain area of ​​health care.

Preventive services: Preventive care appointments, or “preventive services,” as HealthCare.gov puts it, are routine appointments such as screenings, checkups, and the like focused on preventing disease or other problems. health.

Other tools to understand open registration

There are many resources available for those looking to understand health insurance and open online enrollment.

HealthCare.gov, for example, which has a comprehensive glossary of terms, also has additional resources, including guides on comparing plans.

It’s also worth checking out any tools that may be provided by your employer for open enrollment. My company, for example, gave us access to a bot called “Alex”, a kind of digital advisor meant to explain each plan, what it would entail in terms of cost, benefits and how to choose the one that suits your needs. .


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