16 msfocusmagazine.org When you live with multiple sclerosis, it is vital that you understand your health insurance plan in order to manage your disease. Whether you receive insurance through your employer, the healthcare marketplace, or a government insurance, like Medicare,Medicaid,orTricare,therearecertain terms that you must become familiar with to ensure that you follow the rules of your plan to achieve the best possible outcomes. This article will explain and simplify common health insurance terms, acronyms, and abbreviations that every person living with MS should know. Insurance Types • Health Maintenance Organization (HMO) – An HMO delivers all health services through a network of healthcare providers and facilitieswhohavenegotiatedfeesinadvance. A primary care doctor (PCP) is required to manage your care and a referral is often required to see a specialist, such as seeing your neurologist for MS. An HMO typically has lower out-of-pocket costs. • Preferred Provider Organization (PPO) – The main difference between a PPO and an HMO is that a PPO doesn’t require your doctor to be in the network. You don’t have to get a referral from a primary care doctor to see a specialist. While granting more flexibility, upfront and out-of-pocket costs are typically higher. • Point-of-Service (POS) – Is a combination of an HMO and a PPOwherethereisalimited choice of providers in exchange for lower medical costs but you can see out-of- network providers for higher cost to you. • High Deductible Health Plan – These plans charge a higher deductible in exchange for a lower monthly premium. This plan is ideal for people who do not utilize a lot of medical visits or treatments in a calendar year, but want coverage for catastrophes. Insurance Payments • Premium – Is the amount that you pay to the insurance company every month. If you miss a payment or let your premium lapse, then your coverage can be terminated immediately. • Deductible – Is the amount you must pay for covered healthcare services before your insurance plan starts to pay. For example, a plan with a $1,500 deductible means that you pay the first $1,500 before the plan will pay for covered health services. After the deductible is met, there is typically a copay or coinsurance that applies. Typically, the higher the deductible, the lower the monthly premium. It is important to check your plan for the terms of your deductible as there may be certain services – such as ayearlyphysical or chronic disease management – that may be covered bythe plan priorto the deductible being met. Prescription costs may have separate deductibles. Top Health Insurance Terms You Need to Know By Matt Cavallo Hot Topics