Your monthly payment to keep your insurance active — whether or not you use healthcare that month.

The amount you pay out-of-pocket before insurance starts covering costs. A $2,000 deductible means you pay the first $2,000 of bills each year.

A fixed fee for a specific service — like $30 for a primary care visit. Usually due at time of service, even before your deductible is met.

After your deductible, you and your insurer split costs by percentage. With 80/20, insurer pays 80%, you pay 20% — until you hit your out-of-pocket max.

The most you'll pay in a year for covered care. Once you hit this cap, insurance pays 100%. In 2026, ACA caps are $9,200 individual / $18,400 family.

The group of doctors and hospitals that negotiated discounted rates with your insurer. In-network = lower cost. Out-of-network = often full price.

Pre-approval your insurer requires before covering certain procedures or medications. Skip it and the claim may be denied.

Your plan's approved drug list, organized by tiers. Tier 1 (generics) is cheapest. Specialty drugs can cost hundreds per month even with insurance.

A request submitted to your insurer for payment of a service. Your insurer reviews it and sends an EOB showing what they'll cover.

A document from your insurer after processing a claim. Shows what was billed, adjusted, and what you owe. It is NOT a bill.

High-Deductible Health Plan — lower premiums but higher deductibles ($1,500+). The main benefit: qualifies you to open an HSA.

Health Savings Account — triple tax advantage: pre-tax contributions, tax-free growth, tax-free medical withdrawals. 2026 limits: $4,300 individual / $8,550 family.

Continuation coverage after leaving a job. You pay the FULL group premium plus a 2% admin fee — often 3-4x what you paid while employed.

A 60-day window outside Open Enrollment to get coverage after a qualifying life event: job loss, marriage, baby, or moving.