Navigating the Basics of Health Insurance (2024)


Have you ever wondered, “How do I know if my health insurance is good?” or “What do all of these confusing health insurance terms mean?” Understanding health insurance can be daunting, but it’s crucial for making informed decisions about your healthcare. As a seasoned health insurance agent with over three years of experience, I’m here to help. My name is Brian Groberg, and I’ve had the privilege of assisting hundreds of families across the country in finding better health insurance solutions. If you’re seeking guidance, feel free to schedule a call with me here: Schedule a Call.

Navigating Health Insurance: Understanding the Basics

  1. What is a Co-Pay? A co-pay, short for copayment, is a fixed amount you pay for covered healthcare services at the time of your visit. For example, if your co-pay for a doctor’s visit is $20, you will pay $20 when you see the doctor, and your insurance will cover the rest.
  2. What is a Deductible? A deductible is the amount you pay for covered healthcare services before your insurance plan starts to pay. For instance, if you have a $1,000 deductible, you must pay the first $1,000 of covered services yourself before your insurance kicks in.
  3. Should I Choose a High or Low Deductible Plan? The choice between a high or low deductible plan depends on your healthcare needs and financial situation. A high deductible plan typically has lower monthly premiums but higher out-of-pocket costs when you need care. A low deductible plan usually has higher monthly premiums but lower out-of-pocket costs when you need care.
  4. What is a Premium? Your health insurance premium is the amount you pay for your health insurance plan every month. This is separate from any costs you pay for your healthcare services. Premiums are often paid monthly, but they can also be paid quarterly or annually. It’s important to pay your premium on time to keep your health insurance coverage active.
  5. What is Coinsurance? Coinsurance is your share of the costs of a covered healthcare service, calculated as a percentage (e.g., 20%) of the allowed amount for the service. For example, if the total cost of a covered service is $100, and your coinsurance is 20%, you would pay $20, and your insurance would pay the remaining $80. Coinsurance typically kicks in after you’ve met your deductible.
  6. What is an Out-of-pocket Maximum? The out-of-pocket maximum is the most you have to pay for covered services in a plan year. Once you reach this amount, your insurance pays 100% of the allowed amount for covered services. This includes deductibles, coinsurance, and co-payments, but it doesn’t include your premium. Knowing your out-of-pocket maximum can give you peace of mind, knowing there’s a limit to how much you’ll have to pay for covered services in a given year.


Understanding health insurance can be complex, but you don’t have to navigate it alone. As a health insurance agent, I can help you make sense of it all and find the right plan for your needs. Reach out to me today to schedule a conversation: Schedule a Call.

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