09-27-2023 Primtime Living - Flipbook - Page 24
24 A Special Advertising Section of Baltimore Sun Media Group | Wednesday, September 27, 2023
INSURANCE JARGON
Initial understanding
of insurance
Figuring out the jargon to
make sense of it all
By Margit B. Weisgal, Contributing Writer
I
s all the jargon describing insurance policies getting you down? You’re not alone.
You almost need to learn a new language when you start looking at health insurance
options. Even worse, as you delve into the options, what is allowed and what isn’t,
you are never sure you’re comparing similar products.
This is a primer on health insurance.
We’ll cover several areas so when you
dive in, you’ll be a little savvier than
before, and have a grasp of the terminology you’ll come across.
Definition of Terms
Young or old, when it comes to choosing a health care plan, it’s important to
understand all the differences so you get
the best value for your money. The terminology covered here is applicable to plans
that are available through the Affordable
Care Act (ACA), although other health
insurance programs use these terms as
well. The initials describe different types
of plans insurance companies make available, so once you know what they mean,
you are ready to start comparisons.
Depending on where you live, you
may have a limited menu of plans offered
in that jurisdiction. For a complete list
of insurance plans offered in Maryland,
visit the Maryland Health Connection,
Maryland’s access to the ACA: www.
marylandhealthconnection.gov/
The other national resource is
Healthcare.gov. For general information
about all facets of the ACA, also called
Obamacare, this is a good place to start.
Under the aegis of the U.S. Department
of Health and Human Services, as it says
on its home page, “Everyone deserves
access to affordable, quality health care
coverage and services.”
A couple general terms before we get
started.
• Insurance plan types: Plans describe
the different types of insurance you
may buy. But a big feature of that is
the network of providers and facilities you then have access to. Take
into consideration how you access
the various medical professionals as
that makes a difference in the type of
plan you choose.
According to Healthcare.gov, “Some
types of plans restrict your provider choices or encourage you to get care from
the plan’s network of doctors, hospitals,
pharmacies, and other medical service
providers. With others, you’ll pay a greater
share of costs for providers outside the
plan’s network.”
• Network: This term explains any limitations you may have when it comes
to medical providers and facilities.
This is important to understand
because you may be charged more if
you go to a medical provider or facility “outside the network.” The same
insurance company could have different networks for different plans
they offer.
All of what follows are called Managed
Care Plans. A managed care plan is a type
of health insurance. They may or may not
have contracts with health care providers and medical facilities to provide care
for members at reduced costs. These
providers make up the plan’s network.
How much of your care the plan will pay
for depends on the rules as they relate to
that plan’s network(s). These definitions
and more are available at Healthcare.gov.
Exclusive Provider Organization
(EPO): A managed care plan where services are covered only if you use doctors,
specialists, or hospitals in the plan’s network (except in an emergency).
Health Maintenance Organization
(HMO): A type of health insurance plan
that usually limits coverage to care from
doctors who work for or contract with
the plan. It generally won’t cover out-ofnetwork care except in an emergency. An
HMO may require you to live or work in its
service area to be eligible for coverage.
HMOs often provide integrated care and
focus on prevention and wellness.
Integrated Delivery System (IDS):
This is very similar to an HMO, but you are
required to use the insurer’s facility, must
have a primary physician who will oversee
your care and make referrals for you, and
does not cover out-of-network providers
(except in an emergency). These plans
generally have a limited-service area.
Understanding insurance,
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