Health Insurance Terminology Every Texan Should Know

Wading through health insurance terminology can seem like trying to learn another language. But it’s an important task. Having a good grasp of the lingo can empower you to make solid, informed decisions about your coverage.

We explain some of the most common — and confusing — health insurance terminology.

10 Need-to-Know Health Insurance Terms

Deductible

Typically, you must pay your deductible before your health insurance plan starts to pay for covered services. So, if you have a $3,000 deductible, that’s the amount you must pay before your plan kicks in. Once your deductible is paid, you may owe a copayment or coinsurance while the insurance company pays the remaining cost. Usually, the higher the premium, the lower the deductible.

Coinsurance

This is the amount you owe after you’ve paid your deductible. Typically, you pay 100% of the full amount until your deductible is met. Let’s say your coinsurance is 20% of the overall costs. If an office visit costs $100, you’d pay $20 once your deductible is paid.

Health Maintenance Organization (HMO)

HMOs limit coverage to care from specific doctors who are affiliated with the HMO. Out-of-network care may be covered during an emergency, but it depends on the plan’s details.

Preferred Provider Organization (PPO)

PPOs contract with hospitals and doctors to organize a network. Using providers within the network can be more affordable; seeing providers outside the network may carry an additional cost. Typically, a PPO plan offers more flexibility than an HMO plan.

Out-of-Pocket Costs

This is anything you pay for care that’s not covered or reimbursed by your health insurance plan, including coinsurance and deductibles.

Essential Health Benefits

Under the Affordable Care Act (ACA), health insurance plans must cover 10 service categories, including prescription drug coverage, mental health services, and inpatient and outpatient hospital care.

Premium

This is how much your health insurance plan costs on an ongoing basis, whether it’s a monthly, quarterly, or annual payment.

Prior Authorization

You, or your doctor, may need approval from the health plan before receiving or administering care or filling a prescription. This varies from plan to plan.

Summary of Benefits and Coverage (SBC)

This is a snapshot summary of a plan’s offerings that can help you compare costs and coverage between plans. It’s a good idea to use this document when renewing or changing your health care coverage.

Open Enrollment Period (OEP)

This is the annual time frame when you can enroll in an Affordable Care Act, or federal marketplace, health insurance plan. Usually, this period runs from Nov. 1 to Jan. 15, but some states may extend the deadline. You can enroll outside of Open Enrollment if you’ve experienced certain life events, such as getting married or having a baby.

Explore Your Options With Texas Farm Bureau Health Plans

If you’re looking for an alternative to ACA plans, Texas Farm Bureau Health Plans could be a good fit for your needs. Plus, you can tap into the extensive UnitedHealthcare Choice Plus Network. These plans are not traditional health insurance, but they offer several standard health benefits, including coverage for:

• Preventive, routine, and wellness services
• Maternity, newborn, and pediatric care
• Lab work
• Prescription drug benefits
• Emergency room services

There’s no enrollment period for Texas Farm Bureau Health Plans, so you can apply at any time throughout the calendar year. That means you don’t have to wait for Open Enrollment! Get a quote for a Texas Farm Bureau Health Plan today.

Being a Texas Farm Bureau member comes with perks. Learn more about the health savings benefits that can keep your family healthy from head to toe.