Health insurance explained

Learn about the different plans available so you can choose the best one for you and your family

It’s important to have health coverage so you are covered for any illness or injury and have help to pay for medical costs. Health insurance covers expenses for unexpected care and helps maintain your health through preventive care. 

There are several ways to get health insurance:  

• Through your employer. In this case, the employer helps pay for the plan. 
  
• On your own. You can contact an insurance company directly to purchase a plan.
• Through the Affordable Care Act (ACA). The ACA offers a marketplace for you to search for and compare health insurance plans.
   

The key is to understand your needs and match them with the type of insurance that best suits you. 

Depending on the plan you choose, this could include some or all the costs of:

• Visits to urgent care centers
  
• Hospital stays
• Annual and preventive checkups
• Prescriptions
• Other medical needs

Private health insurance

This is the most used type of health insurance because it’s offered through an employer or bought independently through other insurance companies. To keep costs low, some private insurance plans work with specific healthcare providers and facilities. These are part of the plan’s network.

Managed care

This type of care falls into two categories: 

• Health Maintenance Organizations (HMOs) - With a typical HMO plan, you are covered for care from providers in your network only. A referral from your primary care physician (PCP) is required to see a specialist. You usually pay less than for other plans but an HMO may have a smaller network of providers.
  
• Preferred Provider Organizations (PPOs) - With a PPO plan, you have the flexibility to see any doctor that you want – inside or outside your plan’s network – but your costs will be higher when receiving services from non-network providers. If the service isn’t covered, you may be responsible for all billed charges. When you stay in your plan’s network, you save more. Also, you are not required to see a PCP and you do not need a referral to see a specialist.

Two government insurance programs fall under this category: Medicaid and Medicare. Both help eligible people cover their medical expenses. 

• Medicaid - This insurance program is provided state-by-state and helps lower-income people pay for their medical care. It is available only to low-income families and single people who qualify. Requirements differ depending on the state where you live. The program covers most medical care by reimbursing the provider directly. Enrollees may have to pay a small amount for certain care. 
  
• Medicare - Similar to Medicaid, this program is government-run but on the federal level. It provides access to healh care for people age 65 and up and covers some medical costs for people who qualify. People who have certain disabilities or health issues may also qualify. This includes those who suffer from chronic kidney failure who are on dialysis or need a transplant.