Insurance Terminology Information

Your insurance company is the best source of information regarding your benefits.  Before you see any provider, you should contact your insurance company to see if the provider is in-network, and what your associated costs will be.

Below are common terms that you should be familiar with and discuss with your insurance company:


A co-pay is the amount you owe for medical visits.  They can vary by type of provider (specialist, primary care, etc.)  Co-pays are due and collected for every visit until you reach your Out- of- Pocket limit set by your insurance company. 


A deductible is the amount you have to pay for medical care.  Until you pay your full deductible, your insurance company will not make any payments on your medical bills.   Just like auto insurance, your deductible is due first, and then the insurance company pays.   Even when you reach your deductible, you may still have Co-Pays and Co-Insurance due.


Co-Insurance is the percentage that you have to pay of your medical bills.  Many plans are 70/30, 80/20 or 90/10 coverage, meaning you have to pay 30%, 20% or 10% of your bills respectively.  Most plans require you to meet your deductible and then your co-insurance begins.   For example, straight Medicare pays 80% of claims after meeting your annual deductible, so Medicare is 80/20 coverage.


Your Out-Of-Pocket Limit is amount the insurance company sets as the most you will pay in a calendar year for medical bills, including all co-pays, co-insurance and deductibles.    Once you reach your Out-Of-Pocket Limit, most insurance companies pay 100% of any of your medical bills for the rest of the calendar year.  


Your insurance company signs contracts with physicians, and some practices are in-network and some are out of network.  If you see a doctor In-Network, your insurance company will usually pay a higher amount of your medical bills.   Some plans do not have Out-Of-Network benefits, or the Out-Of-Pocket Limit is higher on Out-Of-Network benefits.


A Medicare Advantage plan replaces your Medicare coverage.   A Medicare Supplement is coverage to pay the 20% that Medicare does not pay.   There are many different types of plans.  Please read the fine print before you sign up for either type of plan.    There are many classes and resources for Seniors to help them select the best plan.

Tareen Dermatology

  • Tareen Dermatology - 2720 Fairview Ave N., Suite 200, Roseville, MN 55113 Phone: 651-633-6883
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  • The Hudson Office - 2651 Hillcrest Dr., Suite 304, Hudson, WI 54016 Phone: 651-633-6883

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