Health Insurance Terms You Should Know
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What are the Common Healthcare Insurance Terms? What Do They Mean?
- Deductible – The amount of money you must pay for your health care before your health insurance plan will start to pay for medical insurances.
- Ex. A patient must meet their deductible before the insurance starts covering either a certain percentage or all their therapy.
- Coinsurance – The percentage of costs you are responsible for after you have paid the deductible amount.
- Ex. The insurance will sometimes cover 80% after the patient meets the deductible amount, leaving the patient responsibility of a 20% coinsurance.
- Copay – A fixed amount you pay for a covered health service.
- Ex. Some insurances have a $25 Copay for physical therapy that normally goes towards the patients Out-of-pocket-Maximum. Once they have met the Out-of-pocket-Maximum, the patient will no longer have to pay the copay.
- Out-of-Pocket-Maximum – The most you must pay for covered services in a plan year.
- Ex. Most insurances have a Copay that you will pay for certain services, such as physical therapy, that will apply towards your out-of-pocket-maximum.
- Premium – The amount you pay for you health insurance every month.
- Ex. The certain amount you pay for your insurance that will either come out of your pay from your employer or that you pay individually for through a marketplace.
- Beneficiary – In regards to Physical Therapy insurance, this refers to the covered person or entity in plan.
- In other insurance such as Life Insurance, it refers to the person or entity that will receive the money from your policy’s death benefit when you pass away.
Health Insurance Terminology
Private Insurance vs. Medicare vs. Medicaid
Private Insurance is any health insurance coverage that is offered by a private entity.
Medicare is health insurance program, managed by federal government, for age 65 or older and younger people receiving Social Security disability benefits.
Medicaid helps with healthcare costs for some people with limited income and resources. Medicaid is managed by states & based on income.
PPO vs. HMO vs. FSA
PPO has access to local providers with flexibility to see any other provider who accepts the plan. PPO means Preferred Provider Organization.
HMO must see network providers. If you want to see an outside provider with an HMO plan, you may have to pay the whole cost. HMO means Health Maintenance Organization.
FSA is a savings account used for healthcare expenses, sets aside funds for later use. The funds set aside by the account holder are tax deductible in most cases. Most of the time, the funds must be used within the year. FSA means Flexible Spending Account.
HSA is a Health Savings Account. Funds can be set aside and placed in an HSA for later healthcare use. The funds set aside by the account holder are tax deductible in most cases. HSAs are available for people who have qualifying high deductible health plans. HSA can typically be held over from year to year if they are not used. The government placed limits on the amount that can be placed in an HSA every year.
What is Worker’s Compensation?
Worker’s Compensation is a business insurance that provides benefits to employees who suffer work-related injuries and illnesses. They help pay for medical care, wages from lost work time, and more.
Does Florida Accept Individual (self-employed) Insurance?
Florida does accept Individual Insurance. Florida also has 2 different ways for self-employed people to get insurance. The first option is called an Individual Health Insurance Policy. It’s for just the individual self-employee. The only downside is that you must be healthy and can be denied if you have had previous health issues, such as cancer, diabetes, and weight problems.
The second option is called Florida Group Health Insurance Plan. This is for 2 or more employer/employees of a self-employed company. Benefit is that the certain health issues that can signal an automatic decline on the individual insurance plan can not on the group insurance plan. The only downside is that it can be very expensive.
You can also go to the Individual Health Insurance Marketplace to get insurance. You can also apply here if you are employed at a job as part time and just need insurance. It might just be a little more expensive, but you have many options.
What Insurances are Accepted at JOI Rehab?
We accept most major insurance carriers and their individual plans. These do change from time-to-time, so the only way to know for sure is to call one of our centers to double check. We do offer self-pay rates that are affordable for those individuals without insurance or covered by a plan outside of our contracts.
Please read about our corporate billing and insurance team here.
By: Brittany Smith & Brianna Taylor, JOI Rehab Front Desk & Intake Coordinators
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