Health Insurance 101

Health Insurance 101, A Guide to the Basics

When choosing the right health insurance plan, be sure to consider all the options out there and what each one offers. It is important that you find the right plan for you that also fits your budget. We know that this sounds overwhelming and it may seem like there are a lot of aspects to consider. However, stick with us and we will help you see the light at the end of the tunnel.

If you are looking through the available plans that your employer offers or trying to find coverage on your own, this guide will make that decision a much easier one to make. By the time you finish reading this health insurance guide, you will have a much better understanding of how it works and where your money goes.

Are you living in Boca Raton and looking for affordable health insurance? Need to find a way to reduce your medical expenses in Port St. Lucie or Greenacres? Call us at (561) 420-0280 or click here to learn more. We help our clients in Palm Beach County and up through the Treasure Coast get the affordable healthcare insurance they deserve.

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Understanding how health insurance works.

Health insurance pays for doctors, hospitals, medication, and more. It also pays for preventative care so you’re less likely to get sick. You and the insurance company you choose work together and share the costs of your health care. Don’t forget that all of this applies no matter what type of insurance coverage you get. ACA and private insurance coverage both work this way.

Learn the following terms: copayment, coinsurance, and deductible. These key points determine your part of cost-sharing when picking up prescriptions, visiting your doctor, and staying at the hospital


Sometimes health plans require a small fee for services rendered, this is known as a copayment. This is usually used for visits to the doctor, urgent care, or emergency room, and prescription drugs. Double-check your plan details to be sure.


The amount you pay annually versus what the insurance company pays after your deductible has been met is coinsurance. As an example; you pay 25% of your bills and they pay 75%.


You’ll need to cover any services or supplies not covered by your copayment when you check out until you’ve met your deductible for the year.

Your premium is another key term to learn. This is what you pay annually to the health insurance company to ensure they honor your copayment agreement for healthcare coverage.

Too many health insurance abbreviations to keep up with!

HMO, PPO, HSA, and HRA…. where do you even begin? Don’t be intimidated, these are all terms you should know and as you will see, are easy to grasp.

HMOs and PPOs

These are your two most common forms of insurance coverage. HMO stands for Health Maintenance Organization and PPO is the Preferred Provider Organization.

HMOs require you to choose a primary physician from an approved list (network) and get a referral from your primary doctor to see a specialist, PPOs do not require this. Both plans can charge more for visits to physicians out of your network.

HMOs typically have negligible copays and deductibles while PPOs can cost more for both. Depending on the plan you choose, a PPO can have a higher premium than an HMO plan. Unlike an HMO, a PPO might require you to also file a claim. Both plans could require this if going out-of-network.

An HMO might be your preference if budget is the primary concern for your healthcare. If you would rather have the flexibility to receive care from whomever you prefer, a PPO could be the way to go.

HSAs and HRAs

These two options help pay for services such as medical, dental, vision, and OTC medicines. An HRA or Health Reimbursement Arrangement allows for your employer to reimburse a certain amount to you for those services as well as part or all of your premium. An HSA or Health Savings Account allows you and your employer to contribute a specified amount to help pay for these costs. The main difference is you take that amount with you if you leave your current employer.

OK, I understand the basics of health insurance, so what now?

Don’t go through the process alone, our certified agents are ready to help. We will listen to you to better understand your specific healthcare needs and find the perfect plan to fit your budget. Call Absolute Best Insurance in Greenacres, Port St. Lucie, and Boca Raton at (561) 420-0280 or click here.

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