Are terms like “co-pay” and “deductible” throwing you off? Do you dread your 26th birthday because it means you’ll have to shop for your own health insurance?

If you’re like a lot of 20-somethings, you’re not alone. In a recent study of adults between the ages of 19 and 30, researchers found that 48% can’t define “deductible,” and 78% don’t know how to describe “coinsurance.”

In order to help patients improve their understanding of health insurance, our office at St. Thomas Medical Group has put together this convenient glossary of health insurance terms. Have a billing question? Don’t hesitate to ask us next time you’re visiting with us in the office!

Your Quick & Easy Health Insurance Glossary

Let’s take a few minutes to look at some of the most common health insurance terms and what they mean.

ACA. Short for the “Affordable Care Act,” the ACA – also referred to as “Obamacare” – began to come into effect in 2014 (after being signed into law in 2010). Under the ACA, health insurance policies are frequently purchased by consumers through the government-run Health Insurance Marketplace (if you do not have health insurance coverage through parents or an employer). If you choose to shop for an alternative provider outside the Marketplace, you will want to confirm that your plan is ACA-compliant before purchasing.
Claim. A “claim” describes the process of asking your insurance provider to pay for a medical service. Sometimes the physician’s office will file a claim for you. (If you aren’t sure, it never hurts to ask.)
Copay. Many medical services – like a visit to your primary care provider at St. Thomas Medical Group – may have a copay. This is a flat rate that you pay to access the service; your insurance provider covers the remainder.
Coinsurance. Once you’ve reached your plan’s deductible (see below), you may pay “coinsurance” – a percentage of a healthcare expense. For example, if you have a 25% coinsurance rate, then you would pay $250 of a $1,000 bill, and your insurance plan would pay $750.
Deductible. This is the amount of money you must pay out of pocket before your health insurance plan kicks in. Generally, plans with higher deductibles have cheaper monthly fees and plans with lower deductibles are more expensive.
In-Network Provider. Health insurance plans often have “in-network providers,” which include physicians, hospitals, pharmacies and other healthcare professionals with whom the insurance company has already negotiated lower rates.
Health Savings Account (HSA). This is a personal savings account that you can deposit pre-tax dollars into. The money can be used to pay for a wide range of eligible medical expenses when you need it.
Out-of-Pocket Maximum. This is the most amount of money you can pay for health costs in a year. This figure includes deductibles, copayments and coinsurance. If you spend this amount of money, your insurer should cover the rest of your expenses.
Premium. This is the amount you (or your employer) pays per month for your health insurance policy.

Find a Primary Care Physician in Nashville, TN

For more information, see a primary care doctor in Nashville at St. Thomas Medical Group. Call +1 (615) 297-2700 for more information or to schedule an appointment. Our physicians have offered quality care at the intersection of Green Hills, Sylvan Park and Belle Meade for over 40 years.