<img height="1" width="1" style="display:none" src="https://www.facebook.com/tr?id=1200425829968335&amp;ev=PageView&amp;noscript=1">

9 Health Insurance Terms Millennials Should Know

Health care isn’t growing any less complex. Young people new to health insurance industry terms are having difficulty not only in signing up for plans, but navigating their use, as well. Even young physicians, whose intrinsic knowledge of human anatomy should, in theory, impart additional insight into the health insurance system, are not immune.

That’s because young physicians are new to the system just like everyone else. They tend to be healthy, with most of their past medical expenses having fallen under parent's coverage plans. Even after residency, many young physicians obtain insurance through their employers and may lose some of their grasp on the intricacies of health care coverage once the enrollment process ends.

A detailed knowledge of insurance terms and plan options is becoming increasingly important for all Americans who require health care services, including the very same medical professionals who provide those services.

The following list of nine definitions provides a solid lexicon of health insurance terms so that those new to the marketplace can confidently discuss plan options with their trusted insurance advisors:

  • Benefits: The good stuff. Benefits are the payments, entitlements and services your insurance company agrees to cover.

  • Copayment: When a health insurance company agrees that you will pay a certain amount for a product or service while they pay the rest, your agreed portion of the cost is the “copayment.” A fixed out-of-pocket expense, copays are usually made directly to the provider at the time care is received.

  • Deductible: The amount of money the policyholder must pay out of his own pocket before an insurance company will begin accepting claims. For example, if your deductible is $750, then your insurance will not begin paying for health coverage until you have already spent $750 on medical care.

  • Dependent Coverage: Many plans allow health coverage to run to an insured party’s immediate family or dependents. A “dependent” is a qualifying relative, typically a spouse or child, who relies on another’s income for necessities. The Affordable Care Act requires that insurance companies make dependent coverage available for children up to age 26.

  • In-Network: Health care providers who have contracted to accept your plan’s rates as payment, operating under a managed system such as a preferred provider organization (PPO), are considered to be “in your network.”

  • Lifetime Maximum: The maximum amount of money a health insurance company agrees to pay for a patient’s coverage during the individual’s lifetime. The Affordable Care Act prohibits lifetime maximums for essential health benefits, which includes such categories as emergency services, maternity care and rehabilitative treatment, among others.

  • Out-of-Network: The opposite of in-network, out-of-network health care providers are not subject to your plan’s pricing system and often charge higher prices for services which may not be covered under your plan.

  • Premium: Your most important insurance bill, a premium represents the amount you have agreed to pay the insurance company for coverage. Often paid in monthly installments, premiums are generally higher for health care plans with lower out-of-pocket expenses, such as deductibles.

  • Waiting period: The time that passes before some or all of a health coverage plan kicks in. The Affordable Care Act prohibits employer-sponsored plans from requiring waiting periods of longer than 90 days.

Along with starting a new job or preparing a financial plan, learning to protect one’s health is an essential part of life for new physicians after graduation. Learning the health insurance lexicon is just the first step in a process that will last a career, perhaps a lifetime.

As you prepare to update your health care coverage, start by doing your own research and talking to the people you trust. While gathering information, make a list of what you like best about your current coverage and what you’d like to change. Take that list to your insurance advisors and let them know what you’re looking for in a new policy.

They’ll be able to compare these must-haves with your budget and find the plan that works best for you.

Speak with a TMA Insurance Trust Advisor:

Newsletter signup to receive our monthly newsletter