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A healthcare provider who does not have a contract with a particular health insurance plan. Using out-of-network providers generally costs more than using network providers. Key Features: no contracted rates, higher member costs, limited insurance reimbursement.

The regular payment made to an insurance company to maintain coverage. Key Features: regular (often monthly) payments, varies by policy, does not cover copayments or deductibles.

A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. Key Features: network restrictions, primary care physician requirement, referral-based specialist visits.

A healthcare provider who has a contract with a health insurance plan to provide services to plan members for specific pre-negotiated rates. Key Features: contracted rates, usually lower out-of-pocket costs, part of the insurance network.

An employer-funded plan that reimburses employees for medical expenses not covered by company-sponsored insurance. Key Features: employer-funded, reimburses qualified expenses, typically paired with high-deductible plans.

A savings product that offers a way for consumers to pay for their medical expenses and save for future health expenses on a tax-favored basis. Key Features: tax benefits, high-deductible health plans only, funds roll over.

A federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease. Key Features: age-based eligibility, multiple parts (A, B, C, D), government-funded.

A managed care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan's network (except in an emergency). Key Features: limited provider network, no out-of-network coverage, no referrals needed for specialists.

A decision by your health insurer or plan that a health care service, treatment plan, prescription drug, or durable medical equipment is medically necessary. Key Features: pre-approval requirement, reduces unnecessary procedures, may involve waiting period.

The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance, your health plan pays 100% of the costs of covered benefits. Key Features: spending cap, resets annually, protection from extreme costs.

A type of plan where you pay less if you use doctors, hospitals, and other health care providers that belong to the plan's network. Out-of-network services require a referral and may cost more. Key Features: network-based fees, referral for out-of-network, combines HMO and PPO features.

A state and federal program that provides health coverage for individuals and families with low income and resources. Key Features: income-based eligibility, federally supported but state-managed, comprehensive coverage.

The process by which an insurance company evaluates the risk of insuring a home, car, or individual’s health or life. Key Features: risk assessment, determines premiums, may affect coverage availability.

A document sent by an insurance company to a patient explaining what was covered for a medical service, and what the patient is responsible for paying. Key Features: statement, not a bill, provides detailed information on charges.

A program that provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid but not enough to afford private insurance. Key Features: for low/moderate income families, covers uninsured children, state and federal partnership.

An account you put money into that you use to pay for certain out-of-pocket health care costs. Money is deducted from your income before taxes are withheld. Key Features: pre-tax contributions, employer-sponsored, use-it-or-lose-it policy.

The amount the insured must pay out-of-pocket before the health insurer pays its share. Key Features: annual basis, can vary widely, higher deductible usually means lower premium.

A fixed fee the insured pays for certain medical services at the time the service is rendered. Key Features: fixed amount, paid per service, does not count towards deductible.

The percentage of costs of a covered health care service the insured pays after the deductible has been met. Key Features: percentage based, post-deductible, encourages cost-sharing.