Health insurance is a crucial aspect of our lives. It’s like a safety net that protects us from unforeseen medical expenses. As we gear up for 2024, it’s essential to clearly understand how health insurance works and what benefits it offers. That’s why we’ve put together this guide to help you navigate the complex world of health insurance jargon. In this guide, we’ll discuss some of the most common terms and concepts you’ll come across when dealing with health insurance.

Learn about 2024 U.S. health insurance terms.


Your deductible is the amount you must pay out of pocket before your insurance starts covering your medical costs. For example, if your deductible is $1,000 and you have a medical bill of $1,500, you’ll have to pay $1,000 and your insurance will cover the remaining $500.


A co-pay is a fixed amount for a specific medical service. For example, you might have a $20 co-pay for a doctor’s visit. This means you’ll pay $20 every time you see a doctor, regardless of the total cost of the visit.


Your monthly premium is the amount you pay for your health insurance coverage. This is a set fee you pay regardless of whether or not you use your insurance.

Out-of-pocket maximum

Your out-of-pocket maximum is the most you’ll have to pay for medical expenses in a year. Once you reach this amount, your insurance will cover 100% of your medical costs.

In-network vs. out-of-network

In-network providers are doctors, hospitals, and other medical service providers who have agreements with your insurance company to provide services at a discounted rate. Out-of-network providers don’t have agreements with your insurance company, so you’ll typically pay more to see them.

Pre-existing condition

A pre-existing condition is a health condition you had before signing up for your insurance plan. In the past, insurance companies could deny coverage or charge higher premiums for people with pre-existing conditions, but under current laws, they cannot.


These are just a few of the many terms and concepts you might encounter when dealing with health insurance. By understanding these basic concepts, you’ll be better equipped to make informed decisions about your health insurance coverage.

Know the type of U.S. health insurance plans.

HMO (Health Maintenance Organization):

HMO plans provide affordable healthcare through a network of licensed providers. To enroll, choose a primary care physician (PCP) who acts as your first point of contact. Referral from your PCP is required for specialists or non-emergency care. HMO plans only cover services within their network, except for emergencies.

PPO (Preferred Provider Organization) :

The Preferred Provider Organization (PPO) plan is a flexible healthcare option that allows patients to choose healthcare providers, specialists, and hospitals from a wide network without restrictions. Patients can connect directly with specialists, skip the primary care physician requirement, and seek healthcare outside the network. PPO plans offer personalized healthcare decisions.

Need help with Health Insurance in 2024?

Skyline Benefit is an independent health insurance broker in Fullerton, CA, that offers affordable and flexible health insurance options.  Selecting the best health insurance plans can be overwhelming; our mission is to simplify the process and help our clients every step of the way.

Schedule a consultation today. Call us at: (714) 888-5112

Get a health insurance quote