Health Insurance Guide
What your plan actually means and how to use it. Health insurance confusion is universal—this is the plain-English translation.
Decode My Plan
Enter your plan details and pick a service to see what you'd actually pay — with the math shown step by step.
Premium: What you pay each month regardless of whether you use healthcare. Paying your premium does not mean your care is covered — it just means you have access to the insurance.
Deductible: What you pay out of pocket before insurance starts covering most services. A $3,000 deductible means you pay the first $3,000 of covered medical costs each year. Preventive care (annual physical, vaccines, mammograms) is typically covered at no cost even before the deductible.
Copay: A fixed amount you pay for a specific service ($25 for a primary care visit, $50 for a specialist). Copays usually apply after the deductible is met, though some plans have copays before the deductible for certain services.
Coinsurance: The percentage of costs you pay after meeting your deductible. 80/20 coinsurance means insurance pays 80%, you pay 20%.
Out-of-pocket maximum: The most you will pay in a year for covered in-network services. Once you hit this number, insurance pays 100% for the rest of the year. Knowing your OOP max is critical for planning healthcare.
In-network vs out-of-network: Providers who have negotiated contracts with your insurer (in-network) vs those who haven't. Out-of-network care can cost dramatically more or be entirely uncovered.
EOB (Explanation of Benefits): Not a bill. The document your insurer sends after a claim showing what was billed, what the insurer paid, and what you owe. Read it before paying any bill.