Understanding Health Insurance

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Choosing health insurance is a big decision.

You want to get it right, but it’s not always easy to understand the costs and benefits. Let’s walk through the basics of what you need to know to get started.

What is health insurance?

Health insurance helps you pay for health care. When you sign up for health insurance, you agree to pay a monthly fee called a premium. The insurance company agrees to pay for some of your health care costs. This protects you from the high costs of health care when you go to the doctor or hospital.

What are the costs?

  • The premium is a monthly cost you’ll pay to keep your coverage. Quick tip: Your costs may be lower if you qualify for financial help.
  • The deductible is the amount you’ll pay for health care services before the plan kicks in. After reaching the deductible, you might pay a copay for health care services. Or, you might pay coinsurance, which is usually a percentage of the costs in a bill that comes later. Quick tip: Save money to pay for your deductible so you’re ready for anything. You might consider opening a health savings account (HSA) if you have a high-deductible health plan.
  • Health plans have an out-of-pocket limit for each person and family. Once you reach the out-of-pocket limit, the plan pays for all covered services. Quick tip: Choose a health plan with an out-of-pocket limit you’re comfortable with in case you have a major medical event.

What benefits are covered?

Most health plans cover a set of essential health benefits. Some plans have a network of doctors and facilities. You might pay higher costs if you see providers out of the network. Quick tip: Check to see if your doctor is included in the plan’s network of providers before signing up.

When can I sign up?

If you need health insurance, don’t miss your next chance to enroll:

  • Get ready to enroll from November 1 – January 15. Enrollment timeline
  • Enroll during special enrollment if you have certain life changes like getting married, having a baby, moving or losing a job. Special enrollment
  • Find out if you may qualify for Medicaid any time of year.
  • Native Americans may sign up for health insurance any time of year. Native American enrollment steps