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April 22, 2026

Getting started with important health insurance terms

What is a premium?

Just like you’d pay a fixed monthly fee to join a gym, with insurance, it’s called a premium (the amount of money you pay regularly to have health insurance). You pay this amount whether you use your benefits during the month or not.

  • If you’re enrolled in a Marketplace plan and you qualify for a premium tax credit or subsidy (help from the government to pay your premium), it may cover part or all of the monthly premium.*
  • If you get your health insurance through your job, your premium is usually taken out of your paycheck automatically.
  • If you have Medicare, most people choose to have their premium deducted automatically from their Social Security benefit payment.

What is a network?

Each insurance plan has a group (network) of doctors, hospitals, and pharmacies (providers) who agree to take care of you. Florida Blue negotiates a discounted cost for your care if you go to these in-network providers.

  • When you get care or prescription drugs from an in-network provider, you’ll pay the discounted rate, also called the allowed amount.  This is the smart choice.
  • On the other hand, if you choose an out-of-network provider, you’ll usually pay a higher rate — or even the full cost.

What is a deductible and out-of-pocket maximum? What’s the difference between these and copays and coinsurance?

As you need care throughout the year, every dollar you spend on covered medical care or prescription drugs goes toward your deductible and out-of-pocket maximum.

  • Your deductible is the amount you pay before your insurance starts to help with covered medical or prescription drug costs.
  • Once you meet your deductible, you will only need to pay a portion of the costs. Your share of the cost of these covered services may be in the form of a copays or coinsurance.
    • A copay is a flat fee, like $25, for covered medical care and prescription drugs, usually before you meet your deductible.
    • Coinsurance is a percentage, like 20%, of covered medical or prescription drug costs you pay, usually after you meet your deductible.
  • Your out-of-pocket maximum is the most you’ll pay in a plan year for covered medical and prescription drug costs. Once you reach this amount, your health plan pays 100% of all covered services for the rest of the plan year.

Health insurance offers peace of mind by ensuring there’s a limit to how much you’ll spend out of your pocket on covered medical care and prescription drugs each year.

This gets easier the more you use your benefits!

The more you use your benefits, these terms will become easier to understand. And you’re not alone — your agent or HR team is always there to help until you get the hang of it.

When you’re ready, dig in and explore more about how health insurance works from the Individual Marketplace or through your job or with a Medicare plan. Florida Blue members also can log in to your member account (or use the Florida Blue app) to watch personalized videos about how to save money on your health care costs.

*Does not apply to Medicare plans or those through an employer.