Five sourced questions
Health literacy · 10 answers
The words on your insurance card and bills, in plain English — deductibles, copays, networks, and the rules that quietly decide what you actually pay.
Answer: A summary of what was billed and covered — not a bill
An EOB shows what a provider billed, what the plan paid, and what you may owe. It is not a bill. Compare it with any bill from the provider and ask the plan or provider about differences before paying.
Topic reference: HealthCare.gov glossary · reviewed 2026-07-28
Answer: What you pay for services subject to the deductible before the plan starts sharing those costs
A deductible is the amount you pay for covered services subject to the deductible before the plan begins sharing those costs. Some services can be covered before it. Deductibles, copays, and coinsurance for covered in-network care generally count toward the out-of-pocket maximum; premiums and excluded services do not.
Topic reference: HealthCare.gov glossary · reviewed 2026-07-28
Answer: A fixed amount for a specified covered service
A copay is a fixed amount you pay for a specified covered service, such as an office visit. A plan may use different copays for different services. Coinsurance is different: it is a percentage of the plan's allowed amount.
Topic reference: HealthCare.gov glossary · reviewed 2026-07-28
Answer: In-network providers have agreed to contracted rates and plan rules
In-network providers have contracts with the plan, so covered care generally uses negotiated rates and in-network cost sharing. Out-of-network care can cost more and may allow balance billing, subject to federal and state protections and plan-specific exceptions.
Topic reference: HealthCare.gov glossary · reviewed 2026-07-28
Answer: After certain qualifying life events through a Special Enrollment Period
Certain events — such as losing qualifying coverage, moving in qualifying circumstances, marriage, or having a baby — may open a Special Enrollment Period. The timing and proof rules vary by event. Medicaid and CHIP accept applications year-round, subject to eligibility.
Topic reference: HealthCare.gov glossary · reviewed 2026-07-28
Answer: Approval your plan requires before it will cover certain care
Some care or medicines require the plan's approval before coverage. Missing that step can lead to a denial. If a request is denied, the plan's notice should explain the appeal rights and deadlines; the prescriber or care team may help provide supporting information.
Topic reference: HealthCare.gov glossary · reviewed 2026-07-28
Answer: The most you pay in a plan year for covered in-network benefits that count toward the limit
After eligible deductibles, copays, and coinsurance for covered in-network benefits reach the plan's out-of-pocket maximum, the plan pays 100% of covered benefits for the rest of the plan year. Premiums, non-covered services, and many out-of-network charges do not count.
Topic reference: HealthCare.gov glossary · reviewed 2026-07-28
Answer: A percentage of the allowed amount you pay for a covered service
Coinsurance is your percentage of the plan's allowed amount for a covered service, often after the deductible. It is not necessarily a percentage of the provider's sticker price, and the applicable amount depends on the plan and network status.
Topic reference: HealthCare.gov glossary · reviewed 2026-07-28
Answer: The list of prescription drugs the plan covers
A formulary is the plan's list of covered drugs, usually sorted into cost tiers. If your medicine isn't on it, ask your prescriber about a covered alternative, or request a formulary exception. Checking the formulary before filling can save a surprise at the counter.
Topic reference: HealthCare.gov glossary · reviewed 2026-07-28
Answer: Keep your employer's plan for a time by paying the full premium yourself
COBRA lets you continue the same employer plan, usually up to 18 months, but you pay the full premium plus a small admin fee — so it can be pricey. Compare it against a marketplace plan, since losing job coverage opens a Special Enrollment Period.
Topic reference: U.S. Department of Labor: COBRA continuation coverage · reviewed 2026-07-28
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Explanations draw on public, authoritative sources (HHS/HIPAA, CMS, the No Surprises Act, IRS 501(r), FDA, USPSTF, CDC). General information, not medical advice. Reviewed by MedicalRecords.com Editorial · sources checked July 28, 2026.