Accidents happen. People get sick. With insurance, you can get the care you need without huge medical bills. Getting health insurance also means you can see a range of health care providers when you need to.  

You may need a referral to see certain doctors. FYI: You won’t need a referral to come to Planned Parenthood for expert women’s health care if you want to come to us or have us as an option with a Marketplace or Medicaid health insurance plan.

These plans cover preventive care, including birth control options, for free - without a co-pay. Millions of Americans are newly insured thanks to Obamacare. Learn more about how health insurance works and how to access the care you need.

INSURANCE WORDS TO KNOW

When it comes to health insurance, there are a few terms you will come across that might be confusing. Here are some definitions to help you understand what they mean:

COBRA:

Stands for "Consolidated Omnibus Budget Reconciliation Act." COBRA permits former employees and retirees (as well as their spouses and dependents) to temporarily continue the health coverage they received through their employer by paying the premium themselves.

If your COBRA coverage expires outside of the open enrollment period (the 2016 open enrollment period ended on January 31, 2016), you may qualify for a special exception, and may be able to enroll in a Marketplace plan. Note that you will not qualify for a special exception if you voluntarily terminate your COBRA coverage.

Copay:
Short for "copayment," this is a flat, set fee you pay when you get care, like visiting the doctor or getting a prescription medication, to share the expense with your insurer. For example: You may have a $30 copay to visit the doctor, and then your plan will pay your doctor for the rest of the cost of your visit.

Note: Under the law, if you have health insurance, annual well-woman exams and the full range of prescription birth control options (with the exception of some brands) are available for free – with no copay or deductible.

Deductible:
The amount of money you need to pay each year for certain health care services before your insurer starts to help cover the costs. Plans with lower premiums tend to have higher deductibles, and plans with higher premiums tend to have lower deductibles. Some plans have no deductible at all.

For example: If your plan has a $1,000 deductible, and your first health care cost of the year is a hospital bill for $1,500, you will have to pay the first $1,000 to reach your deductible, then your insurer will pay the remaining amount covered by your plan.

Formulary:
Also called a "drug list," a formulary is an insurance plan's list of covered prescription drugs.

Health Care Provider:
Sometimes shortened to "provider," this is your doctor, nurse, other health care professional or the place where you get health care services. For example: Planned Parenthood, your local hospital and Dr. Smith are all health care providers.

HMO:
HMO is one type of health insurance plan and stands for "Health Maintenance Organization." HMO plans typically have a lower premium, but patients can only use their insurance to receive care at in-network health care providers. An HMO plan may offer fewer options in providers as well. If you have an HMO, and you visit a health care provider that is out-of-network, you will not be able to use your insurance, and you will have to pay the full cost of your services on your own.

In/Out of Network:
Every insurance company has a "network," a list of specific health care providers where you can use your insurance. If you visit an “in-network” provider, your insurance company will cover the cost of your care according to your plan. If you visit an “out-of-network” provider, you will likely have to pay much more for your health care – or pay for all of the cost yourself at the time of service. And some insurance plans don’t cover any of the costs for out-of-network providers.

Note: Some plans include Planned Parenthood as an in-network provider. Some don’t. If you want to come to Planned Parenthood or have us as an option for care with your new insurance, look for a health insurance plan that includes us. To find out which plans include Planned Parenthood, use our plan finder tool.

Insurer:
A company that provides health insurance.

Out-of-pocket maximum:
This is the total amount of money you would ever have to pay in one year for health care, no matter how much care you need. For example: If you have an out-of-pocket maximum of $6,000 and you have a very expensive surgery or treatments, your plan will pay everything after $6,000.

PCP:
Stands for "primary care physician." Primary care physicians provide general health care services and typically focus on providing patients with preventive care and acute treatment services. Some insurance plans, particularly Point of Service (POS) plans, require you to choose a primary care physician and receive referrals from that primary care physician in order to obtain services out-of-network.

POS:
POS is one type of health insurance plan and stands for "Point of Service." This type of plan is a cross between an HMO and PPO because it allows a patient to receive care from out-of-network but only after receiving a referral from the patient's in-network primary care physician.

PPO:
PPO is one type of health insurance plan and stands for "Preferred Provider Option." This type of plan allows a patient to receive services from out-of-network providers, but usually the patient pays more than if they received the same services from an in-network provider.

Premium:
The money you pay your insurer for your health insurance plan. The cost varies depending on the plan you choose and is usually paid monthly.

Note: Millions of Americans will be able to get help paying their premium. In fact, most individuals making between $11,770 and $47,080 per year (families of four making between $24,250 and $97,000) can get financial help. The amount of financial help depends on a few factors, such as annual income and family size.

Qualifying life event:
These are certain events that qualify you for a special enrollment period to enroll in coverage. Examples of qualifying life events to enroll in Marketplace coverage include: losing insurance coverage (unless this loss of coverage resulted from failure to pay premiums or was a voluntary cancellation); having a change in family size (e.g., getting married, losing coverage due to divorce, having or adopting a child); becoming a lawfully present immigrant or citizen; having a change in income that affects your eligibility for financial help (for people already enrolled in Marketplace coverage); and permanently moving to a new state or area with different health coverage options.

Get Updates.

Sign up for important updates about the health care law from Planned Parenthood.

By providing my cell phone number, I agree to receive periodic calls and texts to that number from Planned Parenthood organizations that may be automatically dialed or prerecorded. Message and data rates may apply. STOP to quit receiving texts.

Share this information with your friends.