We don't plan to get sick or hurt, but that doesn't prevent those things from happening to most of us at some point in our lives. That's why health insurance is so important. It protects you from very high expenses and gets you access to the healthcare that you need, when you need it.
Health insurance is there when you need it:
Health insurance is a contract between you and the insurance company. When you buy a plan, the insurance company agrees to pay their part of your medical costs when you get sick or hurt.
Health plans also provide coverage for preventive care to help keep you from getting sick or catching illnesses early. Things like vaccines, screenings, physicals, and maintenance prescription drugs are too easy to ignore if you don't have health insurance, which can lead to serious illnesses or conditions.
The average 3-day hospital stay is around $30,000. The average cost for a broken leg is about $7,500. Having health insurance protects you against paying those expenses out of your pocket.
Premium: A fixed amount that you pay each month for your health insurance plan. This does not include any out-of-pocket expenses that you might incur when you use plan.
Deductible: The amount you pay before the insurance company pays their part on certain expenses such as hospitalizations or outpatient tests and procedures. Once your deductible is met, the insurance company begins to pay for a portion of your costs. Some plans have low deductibles and some have high deductibles. The deductible amount affects the amount of premium that you'll pay for that insurance plan.
Co-insurance. Simply put, this means you pay part and the insurance company pays part. It generally comes into play after your deductible is met for the year. For example, after the deductible, the insurance company might pay 80% and you might pay 20% of eligible charges until you hit your maximum out-of-pocket amount for the year.
Copayment: Often called a copay; it's a fixed amount that you pay for a service. Copays are commonly charged for services like office visits, emergency room care, or prescription drugs. You pay the copay amount (say, $30 for an office visit) instead of the full charged amount (say, $180 for an office visit).
Out-of-pocket maximum: The most you'll pay if you get sick or hurt. Think of it like your financial "worst-case scenario". This can include you deductible, co-insurance, and under the new law, will include copays on most plans as well.