Key Terms to Remember
The amount you have to pay each year before the plan starts paying a portion of medical expenses. All family members’ expenses that count toward a health plan deductible accumulate together in the aggregate; however, each person also has a limit on their own individual accumulated expenses (the amount varies by plan).
OUT-OF POCKET MAXIMUM
This is the total amount you can pay out of pocket each calendar year before the plan pays 100 percent of covered expenses for the rest of the calendar year. Most expenses that meet provider network requirements count toward the annual out-of-pocket maximum, including expenses paid to the annual deductible*, copays and coinsurance.
*Except for Grandfathered medical plans
COPAYS AND COINSURANCE
These expenses are your share of cost paid for covered health care services. Copays are a fixed dollar amount, and are usually due at the time you receive care. Coinsurance is your share of the allowed amount charged for a service, and is generally billed to you after the health insurance company reconciles the bill with the providers.
- EPO/PPO – A network of doctors, hospitals, and other health care providers
- HMO – A network that requires you to select a Primary Care Physician (PCP) who coordinates your health care
- POS – Combines aspects of a PPO and HMO
- HDHP – A plan that has higher annual deductibles in exchange for lower premiums.
For help selecting the right Oregon health insurance plan, contact the experts at NW Strategic Insurance Advisors!
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