Common health insurance terms

  1. Premium & deductible

    A balance of costs
    • The premium is the amount you pay each month for your plan.
    • A deductible is paid for separately and is part of your out-of-pocket cost.

    You'll start the year off paying for your medical bills but only up to the amount of your deductible. Once you've met your deductible, AmeriHealth New Jersey begins to pay its share (for covered services) and you'll only pay the applicable copay or coinsurance. By choosing a plan with a higher premium, you can lower your deductible. A lower premium would give you a higher deductible.
  2. Out-of-pocket cost
    Out-of-pocket cost is the total amount you will pay for health care costs each year. It does not include what you pay for your premium. Most commonly, your deductible, copayments and coinsurance are what make up your out-of-pocket cost.
  3. Referral
    A referral is like an official doctor's note. Your doctor notifies a specialist that you require services from them. After the referral is approved, you can make an appointment with the specialist.
  4. Subsidy
    A subsidy is an amount of money the government is required to pay towards your health insurance. But you have to qualify to receive one, and that depends on your income and the number of people in your household. You could receive tax credits, pay lower prices on health care services and prescriptions, or both.