April 27, 2017

4 Healthcare Terms You Need To Know

The health insurance debate we’ve consistently heard about in the news for the past 5 years has truly been going on for over 85 years. With the Trump Administration in the White House, the Affordable Care Act (often called Obamacare or ACA) is back in the news in a big way.  

How we pay for getting better is complicated. Are you able to define healthcare premium, health plan deductible, out of pocket costs, and coinsurance? Don’t worry if you’re struggling to do so— only 4% of the US population is able to.    

Before we can understand what ACA, Accountable Care Organizations (ACO’s), or value-based healthcare mean, here are a few of the basics of health insurance:  

  • A healthcare premium is the amount you and / or your employer pay each month for a health insurance plan. It can be paid quarterly or yearly.
  • A health plan deductible is how much you must spend before your insurance starts to pay its part toward your medical care. For instance, if your deductible is $1,000, that's how much you have to pay toward the cost of your care before your plan pays anything.  
  • Out-of-pocket costs, sometimes called OOP, are the costs you must pay when you use health care services, such as a visit to the doctor or medication. Some examples include co-pays, deductibles, co-insurance, and out-of-network payments. There are limits on how much of these costs you have to pay. 
  • Co-insurance is the amount of money you must pay for a health service, calculated as a percentage of the total cost of care. For instance, you may have a 20% co-insurance. If a doctor's visit costs $100, then you pay $20; your health plan pays $80. You must pay your deductible before the co-insurance rate starts to apply.

Understanding these terms is important not only when you need affordable medical treatment. Healthcare literacy allows for engaging dialogues about policy in a changing marketplace. In the next blog of the healthcare series, we’ll present a brief history of health insurance in the United States. 

 

Tags: healthcare

Author
Kenneth Amicon

When you run into Ken at the office, you immediately feel his genuine interest in how you're doing at that specific moment in time. Ken's mild-mannered, but intentional care for the people he works with, makes it no surprise that he career double dipped and came back to the TSP team in 2015, previously contributing to the TSP of the mid-90's. Ken knows the people business, and he blends that with a deep knowledge of the Payer, Provider, Health and Property & Casualty Insurance sectors. 

Ken has over 20 years of executive and professional search experience. he has conducted a wide variety of search assignments for large, multi-state healthcare and insurance companies, integrated delivery systems, Pharmaceutical Benefit Management companies, specialty, carve-out and venture capital-backed companies.

Previously, Ken served as a consultant with Witt/Kieffer and was an integral part of their healthcare, managed care, and insurance practices. He holds a Bachelor's Degree from The Ohio State University. 

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