Key insurance terms that start with "P"

The process of comparing different health insurance plans side-by-side to help you choose the best option for your needs. You can compare plans on the Health Insurance Marketplace, and tools like calculators help you estimate what you'll pay. Look at premiums, deductibles, and covered services.

A list or searchable database of doctors, hospitals, and other health care providers in your insurance plan's network. You can use your plan's provider directory to find in-network providers and verify they're accepting new patients before scheduling care.

A health care professional or facility that provides medical services. Providers include doctors, nurses, hospitals, pharmacies, and clinics. Your insurance company contracts with providers to offer you care at negotiated rates.

Your main doctor who coordinates your overall care and provides routine health services. In HMO and POS plans, you choose a PCP and need referrals to see specialists. Your PCP manages your health history and can refer you to other doctors when needed.

Health care designed to prevent disease or catch it early before symptoms appear. This includes vaccinations, screenings, and counseling. The ACA requires all health plans to cover essential preventive services (like mammograms and colonoscopies) for free, with no copay or coinsurance.

Your health insurance plan's coverage of prescription medications. Your plan's formulary lists the drugs it covers and at what cost. Different drugs are in different tiers, so you pay different copays depending on whether the drug is generic, preferred brand-name, or non-preferred.

Financial assistance that lowers your monthly health insurance premiums. The government provides Premium Tax Credits to eligible people based on income. You can receive credits in advance (APTC) or claim them when you file your taxes. Credits are available to people earning up to 400% of the federal poverty level.

See how premium tax credits lower your bill.

The monthly (or yearly) payment you make for your health insurance coverage. The premium is the price of the plan itself, separate from deductibles, copays, and other out-of-pocket costs. Your employer may pay part or all of your premium if you have job-based coverage.

A health insurance plan that offers flexibility in choosing doctors and specialists without needing referrals. You can see any provider, but you pay less for in-network providers. PPOs have higher premiums than HMOs but offer more freedom in choosing care.

A doctor, hospital, or pharmacy that your insurance company prefers you to use. Preferred providers have agreed to discounted rates, so you pay less when you use them. Your plan's provider directory shows which providers are preferred.

Approval from your insurance company before you receive certain health care services or prescriptions. Your doctor usually handles prior authorization, but sometimes you need to request it. Without prior authorization, your claim might be denied, and you'd pay the full cost yourself.

A health insurance plan that combines features of HMOs and PPOs. You choose a primary care doctor and need referrals for specialists (like an HMO), but you can also see out-of-network providers for a higher cost (like a PPO). POS plans offer flexibility with moderate premiums.

A health insurance plan with the highest premiums but the lowest out-of-pocket costs. With a Platinum plan, the insurance company pays about 90% of your covered health costs, and you pay roughly 10%. These plans are most expensive but best if you use health care frequently.

The group of doctors, hospitals, pharmacies, and other health care providers that your insurance company has contracts with. Your insurance company negotiates rates with network providers to keep your costs lower. Using in-network providers is cheaper than out-of-network.