How Do I Use Health Insurance?

Here is some basic info and terminology to help you navigate your new health insurance.

All plans in the Health Insurance Marketplace cover essential health benefits such as emergency services, maternity and newborn care, mental health and substance abuse services, prescriptions drugs, laboratory services, and much more. It's likely your plan offers additional coverage beyond the minimum requirements – you will see exactly what each plan offers when you compare them side-by-side in the Marketplace.

Having health insurance offers you the freedom and convenience to choose a provider that fits your needs. Contact your insurance company directly for assistance finding a provider – many even have simple online searches! When you contact a doctor's office for the first time have your insurance card and policy information available and ensure they accept your insurance plan.

Lastly, it's important to understand the terminology associated with health insurance so you're able to make educated decisions about your care:

Co-pay: A fixed amount you pay to a provider for a covered healthcare service at the time of your appointment. The amount can vary depending on the type of service.

Coinsurance: Your share of the cost of a covered healthcare service, calculated as a percentage. For example, if your coinsurance is 20%, once your deductible is met you would pay $20 for a $100 office visit and your insurance plan would pay the other $80 (or 80%).

Cost Sharing: The amount you pay out-of-pocket for your healthcare services including deductibles, coinsurance, and copayments. This does not include premiums, billing for non-network providers, or the cost of non-covered services.

Deductible: The amount you owe for healthcare services before your health insurance plan begins to pay. For example, if your deductible is $1,000, your plan won't pay anything until you've met your deductible for covered healthcare services. The deductible may not apply to all services.

HMO (Health Maintenance Organization): A type of health insurance plan that usually limits coverage to doctors who work for or contract with the HMO. While HMOs often provide integrated care and focus on prevention and wellness, they may limit the providers or service area in which you are eligible for coverage.

Network: In order to lower health insurance prices, each plan contracts with certain doctors who agree to provide services at a set cost: the provider network. Each insurance company may limit services to doctors within their network and may not cover as much or any of the costs from an "out-of-network" provider.

PPO (Preferred Provider Organization): A type of health plan that contracts with medical providers to create a network of hospitals and doctors. You can see providers outside of the network, but you will typically pay less if you use providers within the plan's network.

Premium: The set amount you pay each month to your insurance company, regardless of whether or not you use your insurance. This is similar to the premium you pay for car insurance. Typically a higher premium will lead to a lower deductible.

Out-of-Pocket Limits: The most you pay during a policy period (typically one year) before your health insurance begins to pay 100% for covered essential health benefits. This limit includes deductibles, coinsurance, and copayments but typically does not include premiums, balance billing for non-network providers, or expenses for non-essential health benefits. The maximum out-of-pocket cost limit for any individual Marketplace plan in 2014 is $6,350 for an individual or $12,700 for a family.

Click here for a full Glossary of Health Coverage and Medical Terms