Your 2026 Health Insurance Cheat Sheet

If you have ever read something from your health plan and paused to make sure you understood it correctly, you are not alone. Health insurance does not come up every day, and when it does, it usually arrives alongside a bill, a statement, or a decision that feels important to get right.

Recent research shows that many people feel this way. In a 2025 analysis from KFF, about three in ten insured adults said it was difficult to understand what they would owe when using their health plan, even for routine care.* Another 2025 study on health insurance literacy found that fewer than half of adults could clearly explain what an Explanation of Benefits, often called an EOB, is or how it is different from a bill.** It is not that people are missing something. These terms just do not come up often, and when they do, there is usually a lot to absorb at once.

This article focuses on the health insurance terms people asked about most in 2025-2026 and explains them in plain language, so they feel easier to recognize and understand when they come up.

How Health Insurance Usually Works
After you receive care, a fairly standard process follows. A claim is sent to your health plan. The plan reviews that claim and then sends you an Explanation of Benefits (EOB) that shows how the claim was processed. If you owe something, the provider may then send a bill.

Understanding a handful of common terms can make this process much easier to follow, especially when paperwork arrives weeks after the visit itself.

About Our Plans
Trustmark major medical plans include Trustmark HealthyEdge^SM plans with a PPO network and Trustmark Healthy Choices^SM reference-based pricing (RBP) plans.

Behind the scenes, PPO plans rely on provider networks, while RBP plans use a standard reference price for services. From a member’s perspective, the same terms still appear on EOBs and bills, which is why this article applies to both plan types.

Common Health Insurance Terms People Asked About Most
A deductible is the amount you may need to pay for covered services before your plan starts paying more. This is one of the most common sources of confusion, especially early in the year. Costs can feel higher at first, and then later in the year the same service may cost less simply because you have already paid more toward your deductible.

A copay is a fixed amount you pay for a service, such as a doctor visit or a prescription. Copays are usually predictable, which is why many people like them. It helps to know that a copay often applies only to the visit itself. Other services that happen during the same visit, such as lab work or imaging, may be billed separately depending on the situation.

Coinsurance is the arrangement by which the cost of Covered Charges is shared by the Participant and us (Trustmark) on a percentage basis. The percentage paid by us (Trustmark) is shown in the Schedule of Benefits.

The out‑of‑pocket maximum is the most you will pay for covered services in a plan year through deductibles, copays, and coinsurance. Many people find this term reassuring once they understand it, because it puts a clear cap on what they pay for covered care during the year.

The allowed amount is the maximum amount your plan says a service should cost. You may also see it called an eligible expense or payment allowance.

This number matters because your deductible, copay, and coinsurance are usually calculated from the allowed amount, not from the provider’s original charge. This is one of the main reasons bills and EOBs can look confusing at first glance. Seeing a high charge does not automatically mean you owe that amount.

Claims, EOBs and Bills
A claim is the request for payment that is sent to your health plan after you receive care. Most people never see the claim itself.

An Explanation of Benefits (EOB) explains how that claim was processed. It is important to know that an EOB is not a bill. An EOB shows what was charged, what the plan allowed, what the plan paid, and what you may owe. Because EOBs are often misunderstood, many people skip them, but reviewing the EOB before paying a bill can clear up a lot of questions.

A provider bill is the request for payment. A simple rule of thumb is that the amount on the bill should match what the EOB says you owe. If it does not, it is worth pausing before paying.

A facility fee is a charge related to the place where you received care, not just the provider you saw.

In some settings, especially hospital‑owned offices or outpatient locations, billing is split into two parts. One charge covers the provider’s services, and a second charge covers the facility itself, such as the space, equipment, and support staff. This can make it look like you were charged twice for one visit, even though the charges are for different parts of the care.

Seeing a facility or access fee does not automatically mean something was billed incorrectly. It usually reflects how the location is classified for billing. Reviewing your Explanation of Benefits can help show how each charge was processed and whether any portion is your responsibility.

If a facility or access fee does not make sense after reviewing your EOB, Trusted Member Care can help you understand what the charge is for and what to do next.

In-Network, Out-of-Network and Balance Bills
In‑network providers have pricing arrangements with the plan, while out‑of‑network providers do not. Because in‑network providers have agreed to set prices in advance, the plan knows what those services will cost, which makes claims easier to price and helps reduce surprises.

As a result, members typically have lower and more predictable out‑of‑pocket costs when using in‑network providers compared to out‑of‑network providers. Out‑of‑network providers have not agreed to these pricing arrangements, so charges and member responsibility can vary more widely.

A balance bill is a bill from a provider for the difference between what the provider charged and what the health plan paid or allowed for the service.

With a Reference‑Based Pricing plan, costs are not based on a traditional provider network. Instead, the plan sets a standard price for services. If a provider does not accept that price as payment in full, you may receive a balance bill. Do not pay balance bills before they are reviewed. Submit them to Trusted Member Care as soon as you receive them so they can be handled appropriately.

Precertification and Prior Authorization
Precertification applies to certain medical services. Some procedures, tests, or treatments need to be reviewed and approved by the plan before they are provided in order to be covered. If precertification is required and not completed, coverage may be affected.

Prior authorization applies to certain prescription medications. Some drugs must be approved before the pharmacy can dispense them at the covered benefit level. Without prior authorization, the prescription may be delayed until approval is in place.

Both precertification and prior authorization help confirm that care and medications meet the plan’s coverage requirements. Checking ahead of time can help avoid delays or unexpected issues.

Additional Source to Look Up Definitions
If you ever want a neutral source for basic health insurance definitions, the Centers for Medicare and Medicaid Services (CMS) maintain a plain‑language glossary called Health Insurance Terms You Should Know.***

When Trusted Member Care Can Help
Many questions can be answered by reviewing your EOB and comparing it to the bill. Trusted Member Care is there for the moments that still do not feel clear. For example, when a bill does not match the EOB, when you receive a balance bill, or when you want help thinking through next steps. It is support you can turn to when you need it, especially when something still feels unclear.

A Simple Takeaway
You do not need to understand every detail of health insurance to use your plan well. Getting comfortable with a few common terms, checking your EOB before paying, and knowing where to turn if something does not add up can make a real difference.

*Navigating the Maze: A Look at Patient Cost-Sharing Complexities and Consumer Protections. KFF. 3/2025. **Health Insurance Literacy Levels: A Recent Survey. Actionable Intelligence for Smarter Decisions. 1/2025.
***Health insurance terms you should know. Centers for Medicare and Medicaid Services (CMS).