Insurance Glossary

Premium: The amount you pay for your health plan each month, regardless of whether you use care.
Deductible: The amount you pay out of pocket for covered services before your plan begins to pay its share.
Copay: A fixed dollar amount you pay for a covered service, such as a doctor visit or prescription.
Coinsurance: The percentage of a covered service you pay after meeting your deductible — for example, 20%.
Out-of-Pocket Maximum: The most you will pay for covered care in a plan year. After you reach it, the plan pays 100% of covered services.
Network: The doctors, hospitals, and pharmacies a plan contracts with. Staying in network usually costs less.
HMO / PPO / EPO: Plan types that differ in how you access care — whether you need referrals, and whether out-of-network care is covered.
Formulary: The list of prescription drugs a plan covers, often organized into cost tiers.
Premium Tax Credit (Subsidy): Financial help that lowers your monthly Marketplace premium, based on your household size and income.
Open Enrollment Period: The yearly window when anyone can enroll in or change an individual health plan.
Special Enrollment Period (SEP): A window outside Open Enrollment, triggered by a qualifying life event, when you can enroll or change plans.
HRA / ICHRA: Employer-funded arrangements that reimburse employees for medical costs or individual insurance premiums, tax-free.
HSA: A Health Savings Account paired with a qualified high-deductible plan, letting you save pre-tax dollars for care. Funds roll over and stay with you.
Medigap (Medicare Supplement): Coverage that pairs with Original Medicare to help pay costs it leaves behind, like deductibles and coinsurance.
Medicare Advantage (Part C): An all-in-one alternative to Original Medicare offered by private carriers, often including drug coverage and extras.
Ancillary Benefits: Coverage that rounds out major medical — such as dental, vision, life, disability, and accident insurance.
EOB (Explanation of Benefits): A statement from your insurer showing what was billed, what the plan paid, and what you may owe. It is not a bill.

Questions? We're here to help.