Talk Health Insurance

Explainers

Six explainers on how health insurance costs work

Each explainer takes one part of a US health plan and works through it with the federal government's own definitions and an illustrative example using round, made-up numbers. Read them in order, or jump to the question you have. For single words, the glossary is quicker.

  1. Explainer 01

    Premiums, deductibles, copays and coinsurance: who pays what, and when

    The four core cost terms in US health insurance, the order they apply in through a plan year, and an illustrative example with round made-up numbers.

  2. Explainer 02

    The out-of-pocket maximum: the ceiling on a year of covered costs

    What the out-of-pocket maximum caps, what never counts toward it, how individual and family limits work, and why premiums sit outside it.

  3. Explainer 03

    HMO, PPO, EPO, POS and HDHP: what the plan-type letters mean

    How the common US plan types differ on networks, referrals and out-of-network care, and how a high deductible plan pairs with a health savings account.

  4. Explainer 04

    In network, out of network and surprise bills

    Why the same visit can cost very different amounts in and out of network, what balance billing is, and what the No Surprises Act protects against.

  5. Explainer 05

    How to read a Summary of Benefits and Coverage

    A section-by-section walk through the standard Summary of Benefits and Coverage form, and how to use it to compare two plans side by side.

  6. Explainer 06

    Drug lists and tiers: how prescription coverage is priced

    What a formulary is, how plans group covered drugs into cost tiers, what generic means, and the coverage rules that can apply before a drug is paid for.