Understanding health insurance terms: KSAT Explains

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Health Insurance

As if picking a plan wasn’t tough enough, you first have to decipher a long list of terms when it comes to health insurance coverage. The KSAT Explains Team put together a glossary to make that tedious task a little easier.

– As if picking a plan wasn’t tough enough, you first have to decipher a long list of terms when it comes to health insurance coverage.“Understanding coverage — it’s something else,” said Anel Trevino, program navigator for theThe collaborative is a nonprofit organization focused on helping people meet critical needs, including housing, health insurance, and more.Trevino estimates the collaborative spends 50% of its time helping people understand terms within their insurance plan.

But if the doctor needs to test for the flu or COVID, the cost of the visit goes up, which means so will the percentage you pay with a coinsurance.The term “out of pocket” refers to anything you are responsible for paying out of your own pocket.An “out-of-pocket maximum” is the highest amount of your own money you will have to pay, usually per year, for medical expenses before your insurance covers the total cost.

A physician or hospital that is out of network, meaning out of your insurance company’s network, does not have that working contract.Under this type of insurance plan, a patient does not need a referral from a primary care physician to see a specialist.

Health Insurance

 

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