Medical Insurance Terms | Simplified For Consumers

Are you a smart consumer? medical insurance terms - simplified

Of course, most of us are! From all the supermarket discounts up to the best deals on purchasing clothes and other things we usually buy, we always tend to be smart shoppers. But unfortunately, this isn’t always the scenario when we shop for healthcare products. This is the reason why we need to start paying attention to the basics, say understanding medical insurance terms.

Most of us just pay for health insurance without scrutinizing the coverage and payables. Back in the day, this is somehow acceptable since health insurance is cheaper. But with all the higher deductibles and out-of-pocket expenses at present, there’s no way we could let our hard-earned money go to waste.

Save money on healthcare by starting to know these common medical insurance terms.


This is your monthly payment for a specific health insurance plan.


This is the amount you pay “out-of-pocket” before your insurance starts paying for your healthcare expenses. Let us say you have $1,000 deductible. After you have spent $1,000 on your medical expenses, this is the point when your insurance starts paying a portion of or all of your costs.


This a small amount you pay each time you use a specific healthcare service. Take note that this payment doesn’t go toward meeting your deductible.


This is a portion you pay for your healthcare expenses after your deductible is met. Let us say you have $1,000 deductible and you’ve already spent $1,000 on your medical services. Your insurance will now start paying 80% of your costs if for instance you have a 20% co-insurance.

Out-of-Pocket Maximum

This is the maximum amount you’ll pay toward your medical services in a given year. Let us say your out-of-pocket maximum is $3,000. Once you have reached this amount, your insurance will have to start paying 100% of your healthcare costs for the rest of the plan year.

Explanation of Benefits (EOB)

This is an informative receipt that gives you the summary of your fees and medical services. Here, you’ll know what you are paying for and allows you to check for potential billing errors if there’s any.


Any person (doctor, nurse, dentist) or institution (clinic or hospital) that provides medical care.


This pertains to the list of doctors or providers approved by your insurance company.


This doctors or providers that are not your included on your insurance’s “in-network” list.

Pre-existing Condition

This pertains to a health problem that existed before the effectivity date of your health insurance.


This is an official notice from a qualified provider/doctor sent to your insurance company that recommends specialist treatment for you.


This is a request that you or your provider submit to your health insurance company when you receive healthcare services. If the claim is valid, either you will be reimbursed or the doctor will get paid.


This is a list of prescription drugs (generic and brand-name) which are covered by your insurance plan.

Preventive Drug List

These medications are covered by your plan even before your deductible is met.

The ins-and-outs of healthcare insurance…

The medical insurance terms above can serve as a head start for smart consumers who want to have the best yet affordable health insurance in the market. We believe that your hard-earned dollars should always get the most effective healthcare plans.

Trusted since 2006, Health Plans In Oregon is here to give you all the information you need to get the most out of your health coverage. Our service is at no cost to you and rest assured that you will be assisted by our professional insurance consultants.

For inquiries on healthcare insurance and Medicare, call 503-998-6169 or simply send an email to

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