What is Health Insurance?

Health insurance covers medical expenses for illnesses, injuries, and preventive care. It helps manage healthcare costs and ensures access to necessary medical services, protecting you from high, unexpected medical bills and providing coverage for routine care to maintain your wellbeing.

Key Benefits

  • Coverage for doctor visits, hospitalization, and emergency care
  • Preventive care often covered at 100% with no out-of-pocket costs
  • Protection from catastrophic medical expenses
  • Access to network discounts for medical services
  • May include prescription drug coverage

Coverage Options

Health Maintenance Organization (HMO)

Lower-cost plans that require you to stay within a network of providers and get referrals from your primary care physician for specialists. Typically have lower premiums but less flexibility.

Preferred Provider Organization (PPO)

More flexible plans that allow you to see providers both in and out of network without referrals, though in-network care costs less. Higher premiums but more provider choices.

Exclusive Provider Organization (EPO)

Combines aspects of HMO and PPO plans. You must use in-network providers (except in emergencies) but don't need referrals for specialists.

High-Deductible Health Plan (HDHP)

Plans with lower premiums but higher deductibles, often paired with tax-advantaged Health Savings Accounts (HSAs) to help cover out-of-pocket costs.

Frequently Asked Questions

What's the difference between deductible, copay, and coinsurance?

A deductible is the amount you pay before insurance begins to pay. A copay is a fixed amount you pay for a service. Coinsurance is the percentage of costs you pay after meeting your deductible.

What is an out-of-pocket maximum?

This is the most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copays, and coinsurance, your insurance pays 100% of the costs of covered benefits.

Can I purchase health insurance outside of open enrollment?

You can purchase health insurance outside of open enrollment if you experience a qualifying life event like marriage, having a baby, or losing other coverage. This creates a Special Enrollment Period.

Are pre-existing conditions covered?

Under the Affordable Care Act, health insurance plans cannot deny coverage or charge more due to pre-existing conditions.