Individual health insurance is purchased by individuals or families on their own, separate from employer group insurance. Individual health insurance plans require more planning. An individual will generally shop for a plan during Open Enrollment (Nov. 1st through Dec. 15th) or after experiencing a qualifying life event. Dependent on your family demographics (age, residency, number of family members enrolling, and income), you may be eligible for tax credits through the Marketplace. These tax credits are used to lower your monthly insurance premium.

Group health insurance is a health insurance plan you extend to your business’s staff and, perhaps, their dependents. With a group health insurance program, small business owners pay either all or part of the cost of the monthly premiums for their employees and typically reap tax benefits as a result. Offering employer benefits is a key element in recruiting and maintaining qualified employees. It has also shown to decrease turnover, reduce absenteeism, and increase productivity.

A health maintenance organization (HMO) is an organization that provides comprehensive health care to a voluntarily enrolled population at a predetermined price. Members pay fixed, periodic fees directly to the HMO and in return receive health care services as often as needed.

A preferred provider organization (PPO) is an association that contracts with a group of doctors, dentists, hospitals or other health care service providers to provide care at prearranged rates or discounts.

It is a specific dollar amount that an individual must pay (or “satisfy”) before reimbursement for expenses begin. Generally, the higher the deductible, the lower the premium of the health insurance plan.

This is the percentage of a covered health care service that you are required to pay (30%, for example). Let’s say your health insurance plan allows $100 for an office visit and your coinsurance is 30%. You would pay 30% of $100 ($30). Your health insurance plan may require you to satisfy a deductible before the coinsurance takes effect.

Health plans help pay the cost of certain prescription medications. You may be able to buy other medications, but medications on your plan’s “formulary” (approved list) are generally less expensive. A copay is the amount you pay when you get a prescription filled. This could mean a fixed copay (for example, $10 for a generic drug or $80 for a brand-name drug) or a percentage (for example, 20 percent of the total cost of a medication). If your medication is on a higher formulary tier (non-generic or non-preferred), you will need to meet your prescription deductible prior to paying copays or coinsurance for prescriptions.

A type of savings account that lets you set aside money on a pre-tax basis to pay for qualified medical, dental and vision expenses. By using untaxed dollars in a Health Savings Account (HSA) to pay for deductibles, copayments, coinsurance, and some other expenses, you may be able to lower your overall health care costs. HSA funds generally may not be used to pay premiums, except for COBRA and Medicare.

While you can use the funds in an HSA to pay for qualified medical expenses, you may contribute to an HSA account only if you have a Qualified High Deductible Health Plan (QHDHP)—generally a health plan (including a Marketplace plan) where the deductible applies to ALL services except preventative services.  For plan year 2020, the minimum deductible for a QHDHP is $1,400 for an individual and $2,800 for a family.

The 2020 contribution limits for health savings accounts (HSAs) are $3,550 for individual coverage and $7,100 for family coverage. There is an additional catch-up contribution limit for those over the age of 55.

Your plan will specify the out-of-pocket maximum (OOP).  This is the maximum amount you may pay for services covered by the plan.  Once that amount is met, you no longer pay coinsurance or copays for the covered medical expenses you sustain during the remainder of the plan year.