Health Insurance Terms and Definitions

One of the most important challenges for most people is actually knowing their health care coverage. Health insurance plans are usually written in a user-friendly way, but many people are unfamiliar with medical and insurance terms. By clicking we get more information about the Weslaco medicare.

Some health insurance plans often contain something equivalent to a cheat sheet that summarises the policy’s coverage and describes the most popular medical facilities. However, you must ensure that you are aware of the numerous products that are not protected by your plan. Most health insurance programmes provide minimal coverage for mental health, chiropractic, and occupational health services. Physical therapy and home health services are often confined to a fixed number of visits each year.

Co-financing or Co-financing

A co-payment is a fixed fee that you usually pay to a care provider for a specific service. When you go to the doctor, for example, you may be asked to pay a $15 co-payment. In this scenario, you would pay $15 at the time of your visit to the doctor’s office. In most cases, you won’t have to pay anything extra because the health insurance provider will cover the rest. However, depending on the health insurance policy, you will be expected to pay a co-payment and then a portion of the remaining balance.

Allowable deductions

A premium is the amount of money you must spend out of pocket for medical costs before the health insurance provider can start offering benefits. Most health insurance policies have a calendar-year deductible, which ensures that the deductible obligation resets in January of each year. So, if the calendar year premium is $1500, the insurance provider will not pay anything for that year as long as your medical costs do not exceed $1500. You must begin paying for $1500 of your own medical bills once the new year begins in January.

Insurance co-financing

The amount or percentage of each medical fee that you are expected to pay is referred to as coinsurance (or out-of-pocket expense). You may have a $100 medical bill, for example. Your health insurance provider will cover 80% of the premium, and you will be responsible for the remaining 20%. Your coinsurance is equivalent to 20% of your premium.

Coinsurance accumulates over the course of the year. If you have a lot of medical bills in a year, you could be able to hit your policy’s coinsurance limit. Any covered charges will be charged in full for the balance of the calendar year at that point.


Tovar Financial Group
12205 N FM 88 Ste A, Weslaco, TX 78599
Phone Number : (956) 647-5736