March 13, 2026
Know Your Health Insurance Lingo: 5 Key Terms You Shouldn't Ignore FHealth insurance can feel like learning a new language, but understanding a few key terms can make a huge difference when it comes to using and choosing your benefits wisely (and avoiding surprise costs). Here's a quick cheat sheet: Deductible- This is the amount you pay out-of-pocket for healthcare services before your insurance shares in costs. Example: If your deductible is $1,500, you pay the first $1,500 in medical bills before your plan starts sharing the cost. Some services may be covered before deductible such as preventative care. Copay- A flat fee you pay upfront for certain services, like $25 for a doctor’s visit or $10 for a prescription. Copays don't count toward your deductible. Coinsurance- Once you’ve met your deductible, you may still pay a percentage of the bill, called coinsurance. For example, if your plan has 20% coinsurance, you pay 20% of the cost and your plan pays the other 80% until you reach your out of pocket maximum. Out-of-Pocket Maximum- This is your safety net! Once you’ve paid this total amount for the year (including deductibles, copays, and coinsurance for ACA plans), your plan covers 100% of eligible costs for the rest of the year. In-Network vs. Out-of-Network- Going “in-network” means you’re using providers who have a contract with your insurance carrier, meaning lower costs for you. “Out-of-network” doctors or facilities can cost much more, and may not be covered at all.