Health Insurance

What is health insurance?

Health insurance is a way to pay for health care. It helps you pay for medical services when you’re injured or sick. You choose a plan and pay a certain amount, called a premium, each month. Some plans require that you pay a co-payment or percentage of each medical bill or a certain amount of money out of pocket each year, called a deductible. Your health insurance then pays some or all of your medical costs.

Each plan is different, but most cover preventive care, like doctor visits and screenings, and part of the costs for hospital visits, emergency room visits, and even prescription drugs. Some plans cover vision and dental, but often you need to get different insurance for these costs to be covered.

What are the different types of health insurance?

Many Americans get health insurance through their jobs, and employers pay part of the cost. The most common kinds of insurance plans include:

  • Health Maintenance Organizations (HMO) and Exclusive Provider Organizations (EPO): You pay a monthly premium and the health plan covers healthcare provider visits, hospital stays, emergency care, lab tests, and therapy. You must use the providers and hospitals chosen by the health plan. With an HMO, you need a referral from your primary care provider to see a specialist.
  • Preferred Provider Organizations (PPO) and Point-of Service plan (POS): You pay a monthly premium and usually a co-payment or a deductible when you see a provider. These plans give you a choice of seeing a provider in a “network” or a provider “out-of-network.” When you visit in-network providers, a larger part of your medical costs are covered. If you see providers who are out-of-network, you pay more. PPO plans usually do not require a referral from your primary care provider to visit a specialist, whether they are in-network or not. POS plans usually require a referral from your primary care provider to specialists that are out-of-network.
  • High Deductible Health Plan (HDHP): You pay a lower monthly fee and higher deductibles than other types of plans. Most HDHP plans include a health savings account that you can use to pay for medical costs.

Other kinds of health insurance include:

  • Catastrophic Health Insurance, which provides coverage if you have a serious accident or illness. The plan does not cover preventive services or prescriptions. The monthly fee is usually lower than other plans, but you may have to pay thousands of dollars before the plan pays your remaining medical costs.
  • COBRA, which lets you continue to pay for health insurance for a certain amount of time after you lose your job
  • TRICARE, which is health insurance for people in the military and their families
  • VA health coverage, which is health insurance for people who were honorably discharged from the Army, Navy, Air Force, Marine Corps, or Coast Guard
  • Medicaid, which is a program that can help pay for the cost of healthcare if you have a low income and limited assets. It is paid by federal and state governments. The program is sometimes called Medical Assistance or Title 19.
  • Children’s Health Insurance Program (CHIP), which provides health coverage for children in families with incomes too high to qualify for Medicaid, but who can’t afford private coverage
  • Medicare, which provides healthcare coverage for people 65 and older. It also provides coverage for people of any age who have certain disabilities or end-stage kidney disease.
  • Retiree coverage, which is health insurance covered by your employer after you retire
  • Long-term-care (LTC) insurance, which covers the care you need if you have a long-term illness or disability. For example, the care may include help with bathing, dressing, grooming, and eating. Most LTC policies cover care in a nursing facility, in-home services, and adult day care programs. The older you get, the more likely you will need long-term care.

How can I get health insurance?

There are several ways to get health insurance:

  • Check with your employer to see if they offer health insurance. You may also be eligible for coverage under a spouse, partner, or a parent’s plan.
  • You can buy an individual policy. Before you get any health insurance policy, make sure you know what it will and will not cover. You can check with insurance companies who offer health insurance or speak to the agent who handles your car or house insurance.
  • If you want to apply for Medicaid, Medicare, or CHIP, you can contact your local office by phone or apply online.

Most people in the US must have health insurance or pay a fee. The US government has set up a web site to help uninsured people find health coverage. You can fill out the Marketplace application, and find out what your choices are for health insurance. For more information, contact:

  • Health Insurance Marketplace
    www.healthcare.gov
    800-318-2596
Developed by RelayHealth.
Adult Advisor 2015.1 published by RelayHealth.
Last modified: 2014-04-23
Last reviewed: 2014-04-23
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
Copyright ©1986-2015 McKesson Corporation and/or one of its subsidiaries. All rights reserved.

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