You’re in good company! As one of the thousands of Californians with CaliforniaChoice health coverage, you’re part of a community that values flexibility and choice.
But how well do you really know your health plan? Let’s make sense of health care together. Understanding key health plan terms can make all the difference for you and your family. Because every one of us deserves clarity and confidence when it comes to our health.
Let’s take a look at the three important health insurance-related terms and what they mean to you.
What is a health insurance premium?
The amount your employer pays (or you and your employer split) for employer-sponsored health insurance. Premiums are usually paid monthly, but payroll deductions might be taken weekly, biweekly, or twice a month.
What is a deductible?
A deductible is a fixed dollar amount (for example, $500), which you or a covered family member must pay for a health care service before your health insurance plan begins to pay.
If the plan deductible is $500, the plan will not pay anything until $500 is paid toward your plan deductible for covered health services (that are subject to the deductible).
Your deductible amount may not apply to all services covered under your health plan.
Under the Affordable Care Act (ACA), some preventive care services may be covered without a deductible. This could change in 2025 depending on a lawsuit challenging some ACA preventive care services. The U.S. Supreme Court is expected to review and rule on this case later this year.
If you or an insured dependent switches health plans during the current calendar year, some insurers may offer a credit for amounts paid toward your deductible under a prior group health insurance plan. This is sometimes referred to a Deductible Credit Transfer.
What is an insurance copayment? (Sometimes also spelled as “co-payment.”)
A co-payment is a fixed dollar amount (for example, $30) that you or your insured dependent must pay for a covered health care service when visiting a health care provider. This amount is usually due at the time the service is provided – not billed after the fact.
The amount could vary based on the type of covered service. An office visit co-payment may differ from an emergency room co-payment.
A related term is an in-network copayment (co-payment). This is a fixed dollar amount (for example, $25) due for covered health care service by providers contracted with your health insurance plan. In-network co-payments are usually less than out-of-network co-payments.
An out-of-network copayment (or co-payment) is a payment due for covered services at out-of-network providers. Out-of-network copayments are typically higher than copayments at in-network providers.
If you and your dependents have questions about other health insurance-related terms, you will find many terms defined on the HeyHealthInsurance.com website.
Your group’s agent or broker can also be a valuable resource. Ask your benefits or HR team for details.