Talk Like a Pro: Insurance Edition
COBRA
OBRA stands for the Consolidated Omnibus Budget Reconciliation Act. It lets you keep your employer-sponsored health insurance for a limited time after losing your job or having your hours reduced.
Coinsurance
Sharing the Bill with Insurance
After you meet your deductible, coinsurance is the percentage you pay for services. For example, you pay 20%, insurance pays 80%.
Copay
A Set Fee for Visits
A fixed amount you pay for certain services, like $30 for a doctor’s visit or $10 for a prescription — even after your deductible is met.
Deductible
Your First Out-of-Pocket Cost
This is the amount you have to pay for your healthcare services before your insurance starts to help out.
Out-of-Pocket Maximum
Your Financial Safety Net
This is the most you’ll have to pay in a year (including deductible, copays, and coinsurance). After that, insurance covers 100%.
Premium
What You Pay Each Month
Like a subscription fee — it's the amount you pay every month to keep your insurance active, whether you use it or not.
Explanation of Benefits (EOB)
The Insurance Receipt
A summary your insurance company sends showing what was covered, what they paid, and what you might owe — not a bill.
HMO vs PPO
- HMO: Lower cost, but requires you to stay in-network and get referrals.
- PPO: More flexibility, no referrals needed, but may cost more.
Marketplace (or Exchange)
Where You Shop for Plans
A government-run site (like Healthcare.gov) where individuals and families can compare and buy health insurance, often with subsidies.
Network
Your Go-To Healthcare Circle
A group of doctors, hospitals, and providers that your insurance works with. Staying “in-network” saves you money.
Subsidy
Help Paying for Insurance
A financial discount from the government to help lower your monthly premium — based on your income and household size.