Health insurance is one of the most important things a family can have—yet many New Yorkers feel completely lost when it comes to understanding how it works. Between all the acronyms, confusing paperwork, and unclear costs, it’s no wonder people feel overwhelmed. Unfortunately, confusion often leads to missed benefits, unexpected bills, or even the wrong coverage entirely.
Table of Content
1.Premium – The Monthly Cost of Staying Covered
2. Copayment – The Fee You Pay for Each Service
3.Deductible – The Amount You Must Pay First
4.Network – The List of Doctors and Clinics You Can Use
5.Prior Authorization – Getting Permission Before You Get Care
6.Why This Glossary Matters More in NYC
7.Real Stories from SecureSafer Clients
8.Need Help Understanding Your Coverage?
That’s why we’ve created this short but essential glossary of five health insurance terms every NYC family needs to know. Mastering just these basics can help you make smarter decisions, save money, and protect your family from coverage gaps. If you’ve ever asked, “Why did I get this bill?” or “What does this letter mean?”—this article is for you.
1. Premium – The Monthly Cost of Staying Covered
A premium is the amount you pay every month to keep your health insurance active. It’s like a subscription—whether you use it or not, you pay this fee to stay covered.
In New York, families with lower incomes may qualify for programs with $0 premiums, such as Medicaid or the Essential Plan. But if you miss a premium payment on private insurance, your coverage may be canceled—even if you were already approved. That’s why it’s critical to understand what your monthly premium is, when it’s due, and how it’s paid. NY State of Health outlines these options.
At SecureSafer, we’ve helped families move from $400/month private plans to Essential Plans with no monthly premium—just by helping them apply through the right channel.
2. Copayment – The Fee You Pay for Each Service
A copayment (or copay) is a flat fee you pay when you use your insurance. This includes doctor visits, prescriptions, urgent care, or lab work. Copays can vary depending on the plan, the provider, and the type of service.
For example, your plan may require a $25 copay for a regular check-up and $10 for a generic prescription. Many Essential Plans in NYC have $0 copays for primary care, which can be a huge relief for families with kids or chronic conditions.
Too often, clients call us in frustration after being charged at a visit they expected to be free. Once we review their plan details, we uncover that it was a copay issue—one they could’ve avoided with a better-fitting plan.
ADVERTISEMENT
3. Deductible – The Amount You Must Pay First
A deductible is the amount of money you must pay for certain services before your insurance kicks in. It’s like a threshold. If your deductible is $1,500, you need to pay that amount out-of-pocket before insurance starts covering costs like MRIs or hospital stays.
For lower-income families, this number can be a dealbreaker. Thankfully, programs like Medicaid or the Essential Plan often come with no deductible. But it’s important to check—some private plans have deductibles over $7,000!
We once helped a Bronx family switch from a Bronze plan with a $6,900 deductible to an Essential Plan with $0 deductible and $0 copays—all without changing their doctors. Learn more about plan designs at Medicare.gov.
4. Network – The List of Doctors and Clinics You Can Use
A network is a list of doctors, hospitals, and clinics your insurance plan has contracted with. If your provider is in-network, your insurance covers more of the cost. If they’re out-of-network, you may be responsible for the full bill.
This is one of the most common issues we see at SecureSafer. A parent finds a “great plan” online—only to discover later that their child’s pediatrician or specialist doesn’t accept it. That’s why we always verify your doctors during enrollment and help you choose a plan that covers your actual needs.
Medicare Advantage and some Marketplace plans may have narrow networks. DFS.ny.gov requires insurers to publish network directories, but they’re often hard to read. We can make it easy.
5. Prior Authorization – Getting Permission Before You Get Care
Prior authorization is when your insurance plan requires pre-approval for a certain service before it agrees to cover it. This commonly includes surgeries, MRIs, home care, and some mental health services.
If you skip this step, your claim may be denied—even if you’re fully covered. This is especially important for OPWDD services, speech therapy, and behavioral health visits. Our brokers at SecureSafer often step in to call the insurance company and speed up these approvals on behalf of our clients.
If your plan requires prior authorization, it should say so in your Summary of Benefits or Evidence of Coverage. Medicare.gov and health.ny.gov both explain this in more detail.
Why This Glossary Matters More in NYC
Living in New York means more options—but also more confusion. Between Essential Plan, Medicaid, Child Health Plus, and private options, it’s easy to feel overwhelmed. Our city also has one of the most diverse provider networks in the country, which means understanding “in-network” and “prior auth” is essential.
Whether you’re in Queens, the Bronx, or Brooklyn, choosing the right plan requires understanding the terms above. It can mean the difference between getting denied for services—or getting the care your family needs, stress-free.
ADVERTISEMENT
Real Stories from SecureSafer Clients
🔹 A Queens father didn’t realize his child’s pediatrician was out-of-network—until he got a $350 bill. We switched him to a plan that covered the doctor, no issues since.
🔹 A Brooklyn mom thought she had to stick with her $600/month plan. We got her enrolled in the Essential Plan with $0 premium.
🔹 A Bronx grandmother’s surgery was delayed due to missing prior auth. Our broker handled it in 24 hours.
Need Help Understanding Your Coverage?
At SecureSafer, we don’t just sell insurance—we explain it. Our NYC-based team speaks your language (literally and figuratively), and we’re here to make health coverage easier, clearer, and smarter for families like yours.
Whether it’s Medicaid, the Essential Plan, Marketplace coverage, or Medicare Advantage—we’ll help you:
- Check your doctors
- Avoid surprise bills
- Pick a plan with no deductible
- Apply for $0 premium options
- Handle paperwork and authorizations
| Health insurance shouldn’t feel like a riddle. With SecureSafer, you get a licensed NYC expert who breaks it all down—and helps you choose the right plan. ✅ Call our SecureSafer team directly at SecureSafer.com or call (646) 444-2020 ✅ Request a policy review or switch evaluation today |
Compliance Note:
This blog is intended for informational purposes only. It does not guarantee eligibility, savings, or plan approval. All benefit and coverage details must be confirmed through official sources including medicare.gov, health.ny.gov, and dfs.ny.gov. Always consult a licensed insurance broker before making any decisions.
ADVERTISEMENT