Help us celebrate and kick off Health Literacy Month in October! Health Literacy Month is a time for organizations and individuals to promote the importance of understandable health information. Throughout the month we’ll be sharing facts about Health Literacy on our Facebook page and raising awareness at our clinics!

In this blog, we’re breaking down some of the more confusing or complicated health insurance phrases you might hear at the clinic. Check out our list below! If you have any recommendations for what you’d like to see defined, be sure to leave a comment.

Health Insurance Terms Explained

What is a Navigator and a Certified Application Counselor?

Indiana Navigators are certified with Indiana Department of insurance to provide application assistance through federally facilitated Marketplace and Indiana Health coverage programs (Medicaid, Children’s Health Insurance (CHIP), Healthy Indiana Plan (HIP). A Certified Application Counselor is a certified consumer assistant that provides Federally-Facilitated Marketplace education and enrollment assistance.

What is the difference between Marketplace insurance and Indiana State health coverage programs?

Marketplace insurance consists of Qualified Health Plans offered to uninsured qualified citizens or lawfully residing immigrants based off annual income. All plans offered cover minimum essential benefits.

You may qualify for Indiana State health coverage plans based off age, income, Indiana residency, and citizenship/immigration status for either little to no cost to you.

What is minimum essential coverage?

Coverage an individual needs have in order to meet the individual responsibility requirement under the Affordable Care Act.

What is the individual responsibility requirement?

The requirement of individuals to maintain coverage for themselves and dependents.

What are the services covered under the minimum essential benefits?

Outpatient care, prescription drugs, emergency care, mental health services, hospitalization, rehabilitative services, preventive and wellness services, laboratory services, pediatric care, maternity and newborn care.

What’s a deductible?

Amount you owe for health care services before your plan begins to pay.

What does out-of-pocket max mean? 

The most you pay during policy period (usually a year) before health insurance pays 100% for services.

What is the explanation of benefits?

Summary of health care charges that your health plan sends you for services received.

What’s a copayment?

Fixed amount you pay for a covered health care service

What is coinsurance?

Charges to pay for after your deductible fulfilled.

What’s the difference between an in-network provider and an out-of network provider?

In-network providers are providers covered under your insurance plan and will charge lower costs for services provided. Out-of-network providers are providers that are not associated with a specific insurance plan that could therefore charge higher costs for services provided in their care.

What is catastrophic coverage?

Plan that has high deductibles and lower premiums, it protects from high out of pocket costs. This is only for adults and it is not eligible for Premium Tax Credits.

We’re Here to Help

Together we can create an open communicative relationship between patients and their provider as well as our patients and health coverage options. We want you to be confident in asking questions and in their health decisions.

The clinics provide free help from Navigator Assisters/Certified Application Counselors. These Navigators see you all the way from your “Coverage to Care” stages.

We, the Family Health Clinic want to break down the barriers of health information and make you feel assured you are receiving and using all of your benefits and getting care to your fullest potential!

Interested in learning more about our free-of-charge Insurance Navigator services? Call (800) 321-5043 and ask to speak to Barb Hickner or Antoinette Valle.