Navigating the world of health insurance can feel like learning a new language. With all the jargon and unfamiliar terms, it’s easy to get lost in the details. However, understanding a few key terms can make managing your health insurance plan much simpler and help you make better, more informed decisions. Here are five essential health insurance terms that you need to know:

1. Premium

Your premium is the amount you pay monthly to maintain your health insurance coverage. Think of it as your “membership fee” to have access to the insurance plan. However, it’s important to note that paying your premium doesn’t necessarily cover the full cost of your medical services. In fact, it’s just the baseline for having coverage. Depending on your plan, your premium could be a small part of the total amount you pay for healthcare each year.

2. Deductible

The deductible is the amount you must pay out-of-pocket for healthcare services before your insurance starts to share the costs. For example, if your deductible is $1,000, you’ll need to pay that amount in full before your insurer kicks in to cover a larger portion of your healthcare costs. But keep in mind, even after you’ve met your deductible, you may still need to pay copayments or coinsurance until you reach your out-of-pocket maximum.

3. Copayment (Copay)

A copayment, often called a copay, is a fixed amount you pay for a specific service or prescription. For instance, you might pay $20 for a doctor’s visit or $10 for a prescription medication. Your insurer typically covers the rest of the cost. Copays often come into play after you’ve met your deductible, and they are one of the ways health insurance companies share costs with you. Copays can vary depending on the service, and some plans have different copays for different types of care (e.g., primary care visits vs. specialist visits).

4. Coinsurance

Coinsurance works similarly to copayments, but instead of a fixed amount, it’s a percentage of the cost. Once you’ve met your deductible, you will be responsible for a percentage of the covered services. For example, if your coinsurance is 20%, and you receive a medical bill for $100, you’ll pay $20, while your insurance covers the remaining $80. Coinsurance continues until you reach your out-of-pocket maximum.

5. Maximum Out-of-Pocket

The maximum out-of-pocket (often called the out-of-pocket limit) is the most you’ll ever have to pay in a year for covered healthcare services. This includes your deductible, copayments, and coinsurance costs. Once you hit this limit, your insurance will cover 100% of your remaining covered medical expenses for the rest of the year. However, remember that your monthly premium doesn’t count toward this limit, so you’ll still need to pay that regularly, regardless of how much you’ve spent on healthcare.

Why These Terms Matter

Understanding these terms is more than just navigating the fine print on your health insurance plan—it’s about making smarter, more informed decisions regarding your healthcare. When you know how these elements work together, you can plan better, budget for expenses, and avoid surprises when it’s time to pay your bills. Whether you’re selecting a new plan or managing your current one, these terms will be critical to understanding your costs and coverage.

Simplify Your Health Insurance Search

At Health Plans of America, we make finding the right health insurance plan hassle-free. Our licensed insurance agents are here to help you navigate through the complex world of health coverage, ensuring you get a plan that works for both your health needs and your budget. Don’t let confusing insurance terminology hold you back—get in touch with us today and take the next step toward securing the coverage you deserve.

HMO, PPO, EPO: Breaking Down Health Insurance Plans Without the Headache

Navigating health insurance can feel like learning a whole new language—HMO, PPO, EPO, copay, deductible… it’s enough to make your head spin.

But don’t worry—we’re here to simplify the jargon and help you understand the most important details so you can choose the best health insurance plan for your needs (and your budget).

Let’s break it down:

HMO: Health Maintenance Organization

Looking for a budget-friendly plan with predictable costs? An HMO might be for you.

• Lower premiums and fixed copays
• Requires you to choose a Primary Care Physician (PCP)
• Referrals needed to see specialists
• Only covers in-network providers

This plan works best if you’re comfortable sticking with one doctor and staying within a defined provider network. Just make sure you choose a PCP you trust—they’ll be your go-to for all things healthcare-related.

PPO: Preferred Provider Organization

If flexibility matters more to you, a PPO plan offers more freedom—at a higher price.

• Higher premiums than an HMO
• No referrals needed to see specialists
• Coverage for both in-network and out-of-network care
• Lower out-of-pocket costs when you stay in-network

A PPO is a solid choice if you regularly visit healthcare providers or want the ability to see specialists without jumping through hoops.

EPO: Exclusive Provider Organization

EPOs are something of a middle ground between HMOs and PPOs.

• Only covers in-network care
• Typically no referrals required
• Larger network than an HMO
• Premiums vary depending on the plan

This plan is great if you’re okay staying in-network but want a wider range of doctors to choose from—and fewer restrictions when seeing specialists.

Final Thoughts

Understanding the differences between HMO, PPO, and EPO plans can make choosing the right health insurance much easier. It all comes down to your healthcare needs, preferences, and budget.

At Health Plan Market, we make it simple to explore your options. Our licensed insurance agents are here to help you find a plan that fits your life—and your wallet.

Ready to get started? Let us guide you to the coverage that works for you.

What is Medigap and Do I Need It?

Have you heard of Medigap and wondered how it differs from a Medicare Advantage plan? It can be confusing to navigate the world of Medicare options, but we’re here to break down the key differences to help you make an informed decision.

Medigap vs. Medicare Advantage: Key Differences

• Premium Costs: Medigap typically has higher premiums compared to Medicare Advantage, which often offers lower monthly costs.
  
• Out-of-Pocket Expenses: With Medigap, you’ll generally pay fewer out-of-pocket costs for medical care. On the other hand, Medicare Advantage tends to have higher out-of-pocket expenses.
  
• Where You Can Receive Care: Medigap is accepted nationwide, so you can receive care anywhere in the U.S. Medicare Advantage, however, is typically limited to specific regions and states.
  
• Provider Network: Medigap doesn’t require you to stay within a specific network of providers, while Medicare Advantage plans do, meaning you’ll need to use in-network doctors and hospitals for the best coverage.
  
• Prescription Drug Coverage: Medigap doesn’t include prescription drug coverage (Part D), so you’d need to enroll separately for that. Medicare Advantage, however, usually includes prescription drug coverage as part of the plan.

Navigating Medicare options can be overwhelming, but you don’t have to do it alone. If you have more questions or need guidance, Health Plans of America is here to help. Their team of licensed insurance professionals is ready to provide you with personalized information and resources, making the decision process easier. Connect with a licensed Medicare specialist near you today!

Traveling This Summer? Here’s What You Need to Know About Medicare Coverage

Are you planning to travel within the U.S. this summer? The good news is that most doctors and hospitals accept Original Medicare. If you experience a sudden illness or injury, Medicare Part B typically covers emergency medical care while you’re away.

However, if you’re heading abroad, there are a few important details to consider. Medicare does not cover medical expenses incurred outside the U.S. This includes not reimbursing for prescription medications you purchase while overseas. That said, Medicare may cover certain services abroad, such as inpatient hospital care, ambulance services, or dialysis in foreign hospitals, but coverage is often limited.

For additional protection when traveling internationally, Medigap (Medicare Supplement insurance) can be a lifesaver. Medigap is designed to work alongside Original Medicare, helping to cover costs that Medicare doesn’t pay, such as copayments, coinsurance, and deductibles. Importantly, some Medigap plans offer emergency medical coverage for situations that occur outside of the United States. This is a huge benefit for anyone who plans to travel abroad and wants peace of mind knowing they’re covered if an unexpected health issue arises.

Not all Medigap plans offer this benefit, so it’s essential to choose the right plan based on your travel needs. Medigap Plan C and Plan F, for example, offer foreign travel emergency health coverage, but you’ll need to check with your provider to ensure it’s included in your specific plan.

In addition to offering overseas protection, Medigap helps cover costs not included in Original Medicare, such as:

• Deductibles: Medigap can help you pay for the out-of-pocket costs associated with Medicare Part A and Part B deductibles.
  
• Coinsurance and Copayments: Medigap covers some or all of the coinsurance and copayments that Original Medicare doesn’t cover.
  
• Extended Hospital Stays: If you require additional hospital days beyond what Medicare covers, Medigap can pick up the cost.

If you’re concerned about medical expenses while traveling or want to reduce your out-of-pocket costs at home, Medigap can provide extra peace of mind.

Still unsure which plan is right for you? Reach out to a live insurance expert at Health Plans of America to discuss your options and get the coverage you need today!

Medigap, also known as a Medicare Supplement plan, is offered by private companies to help cover the costs that Original Medicare doesn’t pay for. This includes expenses like copayments, coinsurance, and deductibles, which can add up quickly without additional coverage.

If you’re someone who enjoys traveling internationally, Medigap plans also offer the added benefit of coverage when you’re outside of the United States—something Original Medicare doesn’t provide. To qualify for a Medigap plan, you must already be enrolled in Medicare Parts A and B.

Medigap vs. Medicare Supplement: What’s the Difference?

There’s often confusion about Medigap and Medicare Supplement plans. To clarify, here are some key distinctions:

• Premium Costs: Medigap premiums tend to be higher than those for Original Medicare.
• Out-of-Pocket Costs: Medigap helps minimize your out-of-pocket expenses.
• Where You Can Receive Care: Medigap works in any state, providing flexibility in where you seek care.
• Provider Network: No network restrictions; you can see any doctor who accepts Medicare.
• Prescription Drugs: Medigap plans do not include prescription drug coverage (Medicare Part D is required for that).

Navigating Medicare and its various plans can be overwhelming, but Health Plans of America is here to make the process easier. A team of licensed insurance professionals are ready to assist, offering expert guidance and resources to help you make informed decisions. Reach out today to connect with a Medicare specialist in your area!

If you need help paying for health insurance in 2025, your eligibility will depend on your income and state of residence. Under the Affordable Care Act (ACA), subsidies have helped reduce costs for millions of Americans. However, the enhanced subsidies that were introduced under the American Rescue Plan Act (ARPA) and extended through the Inflation Reduction Act (IRA) are set to expire at the end of 2025. The Trump administration is not expected to renew these enhanced subsidies, which could make coverage more expensive for many Americans purchasing insurance through the ACA marketplace.¹

As of now, you may still qualify for ACA subsidies if your health insurance costs exceed 8.5% of your household income. However, policy changes under the Trump administration could impact subsidy availability, Medicaid expansion, and other aspects of healthcare access.¹ The benchmark plan used to calculate subsidies remains the second-lowest-cost Silver plan available in your state’s marketplace.

If you rely on ACA subsidies to afford coverage, it’s important to stay informed about potential legislative changes and explore alternative options as policies evolve.

Here are updated tips for estimating your expected household income for 2025 before applying for health insurance savings:

1. Estimate Your Expected Household Income for 2025
   • Start with your Adjusted Gross Income (AGI) from your most recent tax return. If you don’t have an AGI, estimate using federal taxable wages and other income sources.
   • Add any non-taxable income that applies, such as tax-exempt Social Security benefits, foreign income, and tax-exempt interest.
   • Adjust your estimate based on expected raises, job changes, or additional income sources during the year.²
     
     
2. Include the Right People in Your Household
   • Count yourself, your spouse, and all dependents you claim on your federal tax return, even if they don’t need coverage.
   • If a dependent earns enough to file a tax return, their income must be included in your estimate.³
     
     
3. Know the 2025 Income Limits for ACA Subsidies
   • Individuals: Income between $15,060 and $60,240 (100%-400% of the Federal Poverty Level) qualifies for subsidies.
   • Families: A household of four earning up to $124,800 may still qualify for financial help.⁴
     
     
4. Report Any Changes During the Year
   • If your income changes after you apply, update your Marketplace application as soon as possible to ensure you receive the correct subsidy.⁵

Wherever you are in your health insurance journey, Health Plans of America is here to help connect you to a licensed insurance agent.

Sources:
¹ https://revelation-partners.com/the-trump-administrations-impact-on-healthcare-a-2025-outlook
² https://www.healthcare.gov/income-and-household-information/how-to-report
³ https://www.healthcare.gov/income-and-household-information/how-to-report
⁴ https://www.aura-insure.com/post/your-no-nonsense-guide-to-aca-income-limits-for-2025
⁵ https://www.healthcare.gov/income-and-household-information/how-to-report