Affordable Health Insurance Plans for You and Your Family’s Peace of Mind – Coverage That Truly Cares.

Coverage

Coverage refers to the healthcare services and benefits
included in your health insurance plan. This may include doctor visits,
hospital stays, prescription drugs, preventive care, and more. Coverage varies
by plan type and provider.

In-Network vs. Out-of-Network

In-Network: Healthcare providers and facilities that have a contract with your insurance company, typically offering lower costs.

Out-of-Network: Providers and facilities that do not have an agreement with your insurer, often resulting in higher out-of-pocket costs.

Limited Medical Insurance

A type of health plan that provides basic medical coverage
but does not include the full benefits of a comprehensive plan. These plans may
have restrictions on hospital stays, doctor visits, or prescription coverage.

Short-Term Medical Insurance

Designed for temporary coverage, short-term medical plans
provide protection for unexpected medical expenses, such as accidents or sudden
illnesses. These plans are often more affordable but may not cover pre-existing
conditions or essential health benefits required by ACA-compliant plans.

Full Comprehensive Insurance

A health insurance plan that covers a wide range of medical
services, including preventive care, hospital visits, prescription drugs, and
emergency care. ACA-compliant plans fall under this category and include
essential health benefits.

Premium

The monthly amount you pay to maintain your health insurance
coverage. Premiums vary based on plan type, coverage level, age, and other
factors.

Deductible

The amount you must pay out of pocket for covered healthcare
services before your insurance starts to pay. Higher deductible plans often
have lower monthly premiums, while lower deductible plans generally have higher
premiums.

Co-Insurance

A percentage of costs you share with your insurance provider
after you meet your deductible. For example, if your plan has 20% co-insurance,
you will pay 20% of medical expenses, and your insurance covers the remaining
80%.

PPO (Preferred Provider Organization)

A type of health insurance plan that offers flexibility by
allowing you to see any doctor or specialist without a referral. You’ll pay
lower costs if you use in-network providers but can still receive coverage for
out-of-network care at a higher rate.

HMO (Health Maintenance Organization)

A health plan that requires members to use a network of
doctors, hospitals, and specialists. You typically need a referral from a
primary care physician (PCP) to see a specialist, but HMO plans usually have
lower premiums and out-of-pocket costs.

Subsidy

A government financial assistance program that helps
lower-income individuals and families afford health insurance coverage through
the Affordable Care Act (ACA) marketplace. Subsidies can reduce monthly
premiums and out-of-pocket costs.

Out-of-Pocket Maximum

The maximum amount you will pay for covered services in a
plan year. Once you reach this limit, your insurance will cover 100% of
eligible expenses. This includes deductibles, co-payments, and co-insurance but
excludes premiums.

Co-Payment (Co-Pay)

A fixed amount you pay for certain healthcare services, such
as doctor visits, prescription drugs, or urgent care. Co-pays vary by plan and
service type.

Group Insurance

Health insurance coverage offered through an employer,
association, or organization. Group plans typically offer lower premiums and
better coverage options than individual plans.

Catastrophic Health Insurance

A low-cost, high-deductible plan designed for individuals
under 30 or those with a hardship exemption. These plans cover essential health
benefits after you meet the deductible and protect against major medical
expenses.

Essential Health Benefits (EHBs)

A set of healthcare services required by the Affordable Care
Act (ACA) that must be included in all ACA-compliant plans. These benefits
include emergency services, maternity care, mental health services,
prescription drugs, and preventive care.

Health Savings Account (HSA)

A tax-advantaged savings account available to those with
high-deductible health plans (HDHPs). Funds in an HSA can be used for qualified
medical expenses, and unused funds roll over year to year.

Open Enrollment Period (OEP)

The designated time each year when individuals can enroll
in, change, or renew health insurance plans through the ACA marketplace or
employer-sponsored coverage. Outside of this period, you must qualify for a
Special Enrollment Period (SEP) to sign up.

Special Enrollment Period (SEP)

A time outside of Open Enrollment when you can enroll in
health insurance due to qualifying life events, such as marriage, having a
baby, losing coverage, or moving to a new area.

Medicare & Medicaid

Medicare: A federal health insurance program for individuals aged 65+ and certain younger individuals with disabilities.

Medicaid: A state and federally funded program that provides health coverage for low-income individuals and families.

By understanding these health insurance terms, you can make
informed decisions about your coverage options and choose the right plan to fit
your needs. If you're looking for affordable and comprehensive health
insurance, the Health Enrollment Center is here to help you find the perfect plan at the perfect price!