Glossary of Health Insurance Terms

There are many insurance terms and acronyms that tend to make the choice of health insurance more complicated than it needs to be.

This health insurance glossary features key terms you may have heard before and what they mean, so you can be a more informed health care consumer.

HMO (Health Maintenance Organization)

A network of medical professionals, hospitals and facilities who can provide medical care.
A referral from your primary care physician may be required to see in-network specialists.

In-Network / Out-of-Network

A network consists of doctors, specialists, other medical personnel, hospitals and other medical facilities that are contracted to provide medical care.
"In-Network" means that medical providers and facilities are part of your health insurance plan's network.
"Out-of-Network" means what it says; i.e., medical providers who are not in your health insurance plan's network.

Medicare Advantage Plans

Medicare Advantage Plans are a type of Medicare plan offered by private health care companies, not by Medicare itself. Medicare Advantage Plans contract with Medicare to provide coverage for Medicare Part A (doctors) and Part B (hospital). Some Medicare Advantage Plans may include drug, vision and other coverages not provided by Medicare.
Medicare Advantage Plans can be HMOs or PPOs, offering a variety of options for premiums and coverages.
Medicare Advantage Plans are usually based on geographic area, so not all plans offer the same network or coverages. That's why it's important to talk with me!

PCP (Primary Care Physician)

The doctor who is the primary point of contact for your medical care. Think of your PCP as the "hub" of your medical care, determining the specialists you should see.
In an HMO, you may need a referral from your PCP to see a specialist. In a PPO, a referral to see a specialist is not required.

PPO (Preferred Provider Organization)

A network of medical professionals, hospitals and facilities who can provide medical care at lower premiums or co-pays, regardless of your location.
You can also visit with out-of-network physicians, although most likely at a higher rate than in-network.

Supplemental Health Insurance

Most basic health insurance plans do not cover all medical-related costs. Health insurance supplement plans are additional plans that offer peace-of-mind coverage to help you manage health care surprises and costs not included in your basic health insurance plan, such as:

Drugs
Dental
Hearing
Vision
Hospital Indemnity (Out-of-pocket hospital medical and non-medical expense coverage not covered by your basic plan)
Accidental injuries
Cancer treatments
Heart and stroke
Other critical illnesses
Short-term disability