Health Insurance 101.
Medicare
A federal health insurance program for people 65 and older and certain younger people with disabilities.
HMO
A managed care plan where the patient must use physicians from a list of network providers in order to have the expenses paid by the insurance.
PPO
A managed care plan where there is incentive to use physicians from a list of network providers. Typically, the incentive is a higher co-insurance percentage.
Marketplace
A service that helps people shop for and enroll in affordable health insurance.
Out of pocket max (limit)
After you have paid this amount of money, your health insurance will cover 100% of your costs for medical services that are included in your plan.
Medicaid
Insurance program that provides free or low-cost health coverage to some low income people, families and children, pregnant women, the elderly and people with disabilities.
Deductible
The amount of money that an individual pays before the benefits of health insurance kick in and coinsurance starts.
Premium
The amount of money that you and/or your employer pays the insurance company every month or year as part of the insurance plan.
CMS
The federal agency that runs the Medicare, Medicaid, and Children's Health Insurance Programs, and the federally facilitated Marketplace.
Co-pay
The flat fee that an individual is expected to pay for a medical service, such as a doctors appointment.
Co-insurance
The percentage of money that you are expected to pay after the deductible is reached.
