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Understand Insurance Basics
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00:00
[Music] my name is Monica Bryant I am a Cancer rights attorney and Chief Operating
[音樂] 我是Monica Bryant，我是一名癌症權益律師，也是首席營運長。
00:10
Officer for triage cancer a national nonprofit that provides free education on the legal and practical issues that
Triage Cancer的首席營運長，這是一個全國性的非營利組織，提供免費教育，內容涵蓋診斷後可能出現的法律和實際問題。
00:16
can arise after a diagnosis and today we're going to be talking about health insurance health insurance in the United
今天我們要談論的是健康保險。在美國，健康保險。
00:24
States is incredibly confusing there are different places where we can get health insurance and there are different terms
非常令人困惑。我們可以在不同的地方獲得健康保險，而且還有不同的術語。
00:32
specific to understanding health insurance in the United States about 54% of Americans get their insurance from an
這些術語對於理解美國的健康保險至關重要。大約54%的美國人透過。
00:40
employer the other place to get health insurance is through the government primarily through Medicare and
雇主獲得保險。另一個獲得健康保險的途徑是透過政府，主要是透過聯邦醫療保險（Medicare）和。
00:45
Medicaid and then there are people who go straight to a health insurance company to buy individual health
醫療補助計畫（Medicaid）。此外，還有些人直接向健康保險公司購買個人健康。
00:52
insurance but regardless of where somebody gets their health insurance there are some key terms that are
保險。但無論一個人從何處獲得健康保險，都有一些關鍵術語。
00:58
helpful to understand specifically related to how much someone's Health Care is going to cost and the first is
有助於理解，特別是關於一個人的醫療費用將會是多少。第一個是。
01:06
your monthly premium that's the amount that you're going to pay every single month just to have health insurance and
您的每月保費。這是您每個月僅為了擁有健康保險而支付的金額。
01:12
you're going to pay that whether you go to the doctor or not but then when you actually try to access health care there
無論您是否去看醫生，您都必須支付這筆費用。但是當您實際嘗試使用醫療服務時。
01:18
are some additional costs and the first is your annual deductible this is a fixed dollar amount that you have to pay
會有一些額外費用。第一個是您的年度自付額。這是一個固定的金額，您必須先支付。
01:27
before your health insurance kicks in you could have a $500 deductible or a $5,000 deductible depending on the
然後您的健康保險才會開始給付。您可能會有500美元的自付額，或者5,000美元的自付額，這取決於。
01:35
policy once you've met your deductible then your cost share kicks in and cost share is a percentage and it's the
保單。一旦您達到自付額，您的費用分攤就會開始。費用分攤是一個百分比，它是。
01:43
difference between what your insurance company pays and what you pay so if you have an 8020 plan once you meet your
您的保險公司支付的金額與您支付的金額之間的差異。因此，如果您有一個80/20計畫，一旦您達到。
01:50
deductible the insurance company will pick up 80% of your costs and you're responsible for
自付額，保險公司將承擔您80%的費用，而您則負責。
01:56
20% many policies have an additional payment called a co- payment that you pay each time you receive services this
20%。許多保單還有一個額外費用，稱為共同支付（co-payment），您每次接受服務時都需要支付。這。
02:03
again is a fixed dollar amount that's going to depend on the policy and also on the service so you could have a $20
同樣是一個固定的金額，將取決於保單和服務類型。因此，您可能需要支付20美元的。
02:10
co-payment to see a doctor or a $250 co-payment to go to the emergency room one of the most important things
共同支付去看醫生，或者支付250美元的共同支付去急診室。我們所有人最重要的事情之一。
02:18
for us all to understand about our health insurance policies is the outof pocket maximum because in theory that's
要了解我們的健康保險保單，就是自付費用上限（out-of-pocket maximum），因為理論上那。
02:25
the most someone is going to pay out of pocket for their health care during the year year and the way we get to our out-
在一年內，個人在醫療保健方面自付的最高金額。而我們計算自付額上限的方式
02:31
of- pocket maximum is a math problem so typically someone is going to add up everything they've pay towards their
是一個數學問題。通常，個人會將所有已支付的項目加總，包括他們支付的
02:38
deductibles everything they pay towards their co- insurance and everything they pay towards their co-payments so it's
自負額、共同保險費以及掛號費。所以
02:45
everything someone's paying out of pocket except those monthly premiums once someone reaches that out- of pocket
這是個人自付的所有費用，但不包括每月保費。一旦個人達到這個自付額
02:51
maximum the insurance company will pay 100% of their health care costs moving forward now I will say it does depend on
上限，保險公司將支付其 100% 的醫療費用。現在我要說的是，這取決於
02:59
the policy so it's important for everyone to check the outof pocket maximum for their specific policy to
保單。因此，每個人檢查自己特定保單的自付額上限非常重要，
03:04
understand what is included for their plan so thanks for watching this video on health insurance Basics be sure to
以了解其計劃包含哪些項目。感謝觀看這部關於健康保險基礎知識的影片。請務必
03:12
tune in to the rest of the how do I Insurance series for more tips on finding the right health insurance for
收看「我該如何購買保險」系列的其餘影片，以獲取更多關於尋找適合您的健康保險的技巧，
03:18
you and for more information on health insurance be sure to click the link below thank you
並獲取更多關於健康保險的資訊，請務必點擊下方連結。謝謝。
03:27
[Music]
[音樂]

Understand Insurance Basics

📝 影片摘要

本單元由癌症權益律師Monica Bryant主講，主題為美國健康保險的基礎知識。影片開頭說明了取得保險的三種主要管道：雇主、政府（Medicare與Medicaid）以及個人購買。接著，Monica詳細解釋了五個影響醫療費用的關鍵術語：每月保費（Premium）、年度自付額（Deductible）、費用分攤/共同保險（Co-insurance）、共同支付（Co-payment），以及最重要的自付費用上限（Out-of-pocket maximum）。最後，她強調自付費用上限的計算方式（不包含保費），並提醒觀眾務必詳閱自己的保單條款。

📌 重點整理

  • ✓ 美國健康保險主要來源：雇主、政府（Medicare/Medicaid）、個人購買。
  • ✓ 每月保費（Premium）：持有保險的固定成本，無論就醫與否都需支付。
  • ✓ 年度自付額（Deductible）：保險給付前，個人需先支付的金額。
  • ✓ 費用分攤（Cost Share/Co-insurance）：達自付額後，保險與個人按比例分擔費用（如80/20）。
  • ✓ 共同支付（Co-payment）：每次接受服務時需支付的固定金額（如掛號費）。
  • ✓ 自付費用上限（Out-of-pocket maximum）：一年內個人醫療支出的最高金額（不含保費）。
  • ✓ 達到上限後：保險公司將支付100%的醫療費用。
  • ✓ 重要提醒：每個保單的術語與數字不同，必須親自確認條款。
📖 專有名詞百科 ｜點擊詞彙查看維基百科解釋
保費
premium
自付額
deductible
保單
policy
費用分攤
cost share
共同支付
co-payment
緊急情況
emergency
最大值
maximum
自掏腰包的
out-of-pocket
保險
insurance

🔍 自訂查詢

📚 共 10 個重點單字
premium /ˈpriːmiəm/ noun
The amount paid for an insurance policy.
保費；保險費。
📝 例句
"That's the amount that you're going to pay every single month just to have health insurance."
→ 這是你為了擁有健康保險而每個月必須支付的金額。
✨ 延伸例句
"Paying the premium on time keeps your policy active."
→ 按時繳納保費可維持保單有效。
deductible /dɪˈdʌktəbl/ noun
A fixed amount you must pay before your insurance kicks in.
自付額；免賠額。
📝 例句
"This is a fixed dollar amount that you have to pay before your health insurance kicks in."
→ 這是一個固定的金額，你必須先支付，然後你的健康保險才會開始給付。
✨ 延伸例句
"My car insurance has a $500 deductible."
→ 我的車險有500美元的自付額。
policy /ˈpɒləsi/ noun
The official document detailing the terms of an insurance contract.
保單；保險契約。
📝 例句
"You could have a $500 deductible or a $5,000 deductible depending on the policy."
→ 根據保單不同，你的自付額可能是500美元或5,000美元。
✨ 延伸例句
"You should read your policy carefully to understand what is covered."
→ 你應該仔細閱讀保單以了解涵蓋範圍。
cost share /kɒst ʃeər/ noun phrase
The percentage of costs you pay after meeting your deductible.
費用分攤；共付額。
📝 例句
"Once you've met your deductible then your cost share kicks in and cost share is a percentage."
→ 一旦你達到自付額，你的費用分攤就會開始，而費用分攤是一個百分比。
✨ 延伸例句
"The plan has a low premium but a high cost share."
→ 這個計劃保費低但費用分攤比例高。
co-payment /ˈkoʊ ˈpeɪmənt/ noun
A fixed amount you pay each time you receive services.
共同支付；掛號費。
📝 例句
"Many policies have an additional payment called a co-payment that you pay each time you receive services."
→ 許多保單還有一個額外費用，稱為共同支付，你每次接受服務時都需要支付。
✨ 延伸例句
"There is a $20 co-payment for generic drugs."
→ 學名藥的共同支付是20美元。
emergency /ɪˈmɜːrdʒənsi/ noun
A serious, unexpected, and often dangerous situation requiring immediate action.
緊急情況；急診。
📝 例句
"Or a $250 co-payment to go to the emergency room."
→ 或者去急診室需要支付250美元的共同支付。
✨ 延伸例句
"Call emergency services if the situation worsens."
→ 如果情況惡化，請撥打緊急服務電話。
maximum /ˈmæksɪməm/ noun
The greatest amount, extent, or intensity possible.
最大值；上限。
📝 例句
"One of the most important things for us all to understand about our health insurance policies is the out-of-pocket maximum."
→ 我們所有人要了解健康保險保單最重要的事情之一，就是自付費用上限。
✨ 延伸例句
"There is a maximum limit on how much you can withdraw."
→ 提款金額有上限。
out-of-pocket /aʊt əv ˈpɒkɪt/ adjective
Paid for directly by an individual rather than by insurance.
自掏腰包的；自付的。
📝 例句
"That's the most someone is going to pay out of pocket for their health care during the year."
→ 那是個人在一年內為醫療保健自付的最高金額。
✨ 延伸例句
"The surgery cost him $2,000 out-of-pocket."
→ 這場手術花了他自付的2,000美元。
deductibles /dɪˈdʌktəblz/ noun (plural)
Plural form of deductible; the amounts paid before insurance coverage starts.
自付額（複數）。
📝 例句
"Someone is going to add up everything they've pay towards their deductibles."
→ 某人將會加總他們支付的所有自付額。
✨ 延伸例句
"High deductibles usually mean lower monthly premiums."
→ 高自付額通常意味著較低的月保費。
insurance /ɪnˈʃʊrəns/ noun
A practice or arrangement by which a company provides a guarantee of compensation for specified loss.
保險。
📝 例句
"The insurance company will pick up 80% of your costs."
→ 保險公司將承擔你80%的費用。
✨ 延伸例句
"It is wise to have health insurance."
→ 擁有健康保險是明智的。
🎯 共 10 題測驗

1 What percentage of Americans get their health insurance from an employer? 大約百分之多少的美國人透過雇主獲得健康保險？ What percentage of Americans get their health insurance from an employer?

大約百分之多少的美國人透過雇主獲得健康保險？

✅ 正確！ ❌ 錯誤，正確答案是 C

The speaker states that about 54% of Americans get their insurance from an employer.

講者指出約54%的美國人透過雇主獲得保險。

2 Which of the following is a fixed dollar amount you must pay before your health insurance kicks in? 下列哪一項是你在健康保險生效前必須支付的固定金額？ Which of the following is a fixed dollar amount you must pay before your health insurance kicks in?

下列哪一項是你在健康保險生效前必須支付的固定金額？

✅ 正確！ ❌ 錯誤，正確答案是 B

The video defines a deductible as a fixed dollar amount you have to pay before insurance pays.

影片定義自付額為在保險支付前你必須支付的固定金額。

3 In an 80/20 plan, what percentage does the insurance company pay after the deductible is met? 在80/20計劃中，一旦達到自付額，保險公司會支付多少百分比？ In an 80/20 plan, what percentage does the insurance company pay after the deductible is met?

在80/20計劃中，一旦達到自付額，保險公司會支付多少百分比？

✅ 正確！ ❌ 錯誤，正確答案是 C

In an 80/20 plan, the insurance company picks up 80% of the costs.

在80/20計劃中，保險公司會承擔80%的費用。

4 What is the term for a fixed amount you pay each time you receive a specific service, like seeing a doctor? 每次接受特定服務（如看醫生）時需支付的固定金額，稱為什麼？ What is the term for a fixed amount you pay each time you receive a specific service, like seeing a doctor?

每次接受特定服務（如看醫生）時需支付的固定金額，稱為什麼？

✅ 正確！ ❌ 錯誤，正確答案是 C

This specific fixed amount is called a co-payment.

這個特定的固定金額稱為共同支付（Co-payment）。

5 What is the maximum amount you pay out of pocket for health care in a year (excluding premiums)? 一年內你為醫療保健自付的最高金額（不含保費）是什麼？ What is the maximum amount you pay out of pocket for health care in a year (excluding premiums)?

一年內你為醫療保健自付的最高金額（不含保費）是什麼？

✅ 正確！ ❌ 錯誤，正確答案是 B

The speaker calls this the 'out-of-pocket maximum'.

講者稱之為「自付費用上限」。

6 Who pays 100% of health care costs once the out-of-pocket maximum is reached? 一旦達到自付費用上限後，誰會支付100%的醫療費用？ Who pays 100% of health care costs once the out-of-pocket maximum is reached?

一旦達到自付費用上限後，誰會支付100%的醫療費用？

✅ 正確！ ❌ 錯誤，正確答案是 D

Once the out-of-pocket maximum is reached, the insurance company pays 100%.

一旦達到自付費用上限，保險公司會支付100%。

7 Which government program is NOT mentioned as a source of health insurance in the video? 影片中沒有提到哪個政府計畫是健康保險的來源？ Which government program is NOT mentioned as a source of health insurance in the video?

影片中沒有提到哪個政府計畫是健康保險的來源？

✅ 正確！ ❌ 錯誤，正確答案是 C

The video mentions Medicare and Medicaid but does not mention Social Security as a health insurance source.

影片提到了Medicare和Medicaid，但沒有提到社會安全保險（Social Security）作為健康保險來源。

8 Which of the following costs is NOT included in the calculation of the out-of-pocket maximum? 下列哪項費用不包含在自付費用上限的計算中？ Which of the following costs is NOT included in the calculation of the out-of-pocket maximum?

下列哪項費用不包含在自付費用上限的計算中？

✅ 正確！ ❌ 錯誤，正確答案是 C

The speaker explicitly states that monthly premiums are not included in the out-of-pocket maximum calculation.

講者明確指出月保費不包含在自付費用上限的計算中。

9 Besides employer and government, what is the third way to get health insurance mentioned? 除了雇主和政府之外，影片中提到的第三種取得健康保險的方式是什麼？ Besides employer and government, what is the third way to get health insurance mentioned?

除了雇主和政府之外，影片中提到的第三種取得健康保險的方式是什麼？

✅ 正確！ ❌ 錯誤，正確答案是 A

The speaker mentions people who go straight to a health insurance company to buy individual health insurance.

講者提到有些人直接向健康保險公司購買個人健康保險。

10 What could be a co-payment amount to see a doctor according to the video? 根據影片，看醫生的共同支付金額可能是多少？ What could be a co-payment amount to see a doctor according to the video?

根據影片，看醫生的共同支付金額可能是多少？

✅ 正確！ ❌ 錯誤，正確答案是 B

The speaker gives an example of a $20 co-payment to see a doctor.

講者舉例看醫生的共同支付是20美元。

測驗完成！得分： / 10

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