Underinsured

Individuals who have health insurance coverage but face significant out-of-pocket expenses or have coverage limitations that may not adequately meet their healthcare needs.

 

Cost-Sharing:

The portion of healthcare expenses that individuals with insurance must pay out of their own pockets, including deductibles, copayments, and coinsurance.

 

High-Deductible Health Plan (HDHP):

A type of health insurance plan with a higher-than-average deductible, often chosen by individuals seeking lower premium costs but potentially leaving them underinsured for certain medical expenses.

 

Catastrophic Health Insurance:

A type of health insurance designed for young, healthy individuals, offering low premiums but with high deductibles. It provides coverage for major medical expenses after reaching the deductible.

 

Out-of-Pocket Maximum:

The maximum amount an individual is required to pay for covered healthcare services in a given period, after which the insurance plan typically covers 100% of eligible expenses.

 

Health Savings Account (HSA):

A tax-advantaged savings account paired with a high-deductible health plan, allowing individuals to save money for qualified medical expenses.

 

Preventive Services:

Healthcare services aimed at preventing or detecting health issues early, often covered by insurance plans at no cost to the individual. However, underinsured individuals may still face barriers to accessing preventive care.

 

Coverage Gap:

A situation where individuals have health insurance but may find themselves lacking adequate coverage for specific healthcare services, leading to out-of-pocket expenses.

 

Medically Necessary:

Healthcare services or treatments deemed essential for a person’s health, which may or may not be fully covered by an insurance plan.