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Terms You Must Understand When Shopping For Affordable Health Insurance

Most individuals have at least a basic understanding of their health insurance coverage. However, have you ever taken a moment to have someone explain health insurance costs to you? You know the amount you're paying every month for your health insurance premium, or the amount that you contribute toward an employee sponsored plan, so it's easy to know when this cost increases, but what about all the other costs involved with health insurance? Do you know what they mean and how your choices with regard to them can affect your overall health insurance costs? Before you're hit with an excessively large medical bill, be sure to read the following explanation of health insurance costs.


The premium is the amount you'll pay for the benefits covered under your health insurance plan. The premium is typically broken down into equal monthly payments. If you've got group insurance, your employer or a union is probably sharing some percentage of this cost. Often you can receive a discount and save on processing fees if you pay your premium annually. Depending on the savings, this may be a good option to consider.

The Deductible

If your health insurance policy includes an annual deductible, it's important to understand the details. A deductible is an amount that you are responsible for paying before the insurance company begins paying out claims. A family health insurance plan typically includes multiple deductibles, one for each family member and a maximum family deductible.

As with most types of insurance, the higher you set your deductible, the lower your monthly premium. This is a good way to make health insurance more affordable. However, be sure that you can afford to potentially pay any higher deductible you may choose.

The Co-Payment

A co-payment is a fixed amount that you, the insured, must pay each time you visit the doctor. The co-payment amount differs based on the type of health insurance plan you have. For example, an HMO will have the lowest co-payment. The co-payment can however, increase for different types of medical service and/or if you go outside the network (if your health insurance plan requires you to stay within a network). Indeed, in order to keep costs to a minimum, try to stay within your network.


Co-Insurance is the amount of a claim that you, the insured, are responsible for paying, once the deductible has been met. A typical ratio is 80/20 where the insurance company pays 80% of a claim and you pay 20%. Your percentage will typically increase when you go outside the network, so as with your co-payment, it pays to stay within your network if at all possible.
Also, in situations where the claim exceeds what the insurance company deems 'reasonable and customary' you are responsible for the difference.

Understanding the above health insurance terms and their costs is not only important when using your insurance, but should be discussed or reviewed carefully when requesting quotes, especially online health insurance quotes. When you're comparing quotes from different insurance companies, it's important to know all your costs, not just the premium. Make sure the person preparing your quote clearly defines the deductible amount and whether there is a separate deductible for different types of services, the co-payment amount and the co-insurance amounts. Also ask the person to elaborate on other costs that may not be readily apparent.

As health insurance costs continue to increase year after year, it can take a real effort to keep costs as low as possible. Always stay within your network whenever possible. If you can choose any medical care professional, be sure that the fees for the services you'll need fall within your insurance company's 'reasonable and customary' guidelines. If not, shop around for a less expensive provider. Other tips for keeping health insurance costs as low as possible include living a healthier lifestyle and seeking medical care only when absolutely necessary.

About the Author: Jonathon James has been working in the health insurance industry for nearly twenty years. For additional tips and information about affordable family health insurance, please be sure to visit

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