Health insurance basics
Know what you’re comparing.
A few clear definitions can make coverage decisions easier. Start with what you pay and how you access care.
Get a Free QuoteRead a plan in two parts.
Your costs
The premium and what you pay when using care.
Your access
The providers, prescriptions and services included.
The language of what you pay.
These terms describe different parts of the cost. Check how they work together in the plan you are considering.
Premium
The amount you pay to keep a policy active, usually each month. You may still have costs when receiving care.
Deductible
What you pay for covered services before the plan begins paying for certain benefits. Some services may be covered before you meet it.
Copay & coinsurance
A copay is a set amount for a covered service. Coinsurance is your share as a percentage of the plan’s allowed cost.
Out-of-pocket limit
Under a comprehensive plan, this limits cost-sharing for covered, in-network services during the plan year. Premiums and noncovered care do not count toward it.
A plan also has to work with the care you use.
Check these details under the exact plan, even if the insurer’s name is familiar.
Provider network
The doctors, hospitals and providers contracted with a plan. Confirm participation with your provider too.
Formulary
The prescription drug list. Check medication, dosage, tier, pharmacy and any approval requirements.
Compare the whole picture.
Look at the premium alongside expected care costs. Then check doctors, prescriptions, benefits and exclusions.
One useful question
“What would I pay in a typical year, and what could I pay if I needed more care?”
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