How does health insurance work

Let’s keep it simple: Health insurance helps cover eligible medical costs when you need care.

You pay a monthly premium for the insurance plan.

When you need care, your health plan helps pay for covered services like doctor visits, prescriptions, lab tests, and hospital care.

Here’s a quick breakdown of how it works:

Premium: What you pay each month for the insurance plan

Deductible: The amount you pay each year before your plan starts sharing costs

Copay/Coinsurance: Your share of the cost when you receive care

Out-of-pocket maximum: The most you’ll pay in a year before your plan pays 100 percent of eligible expenses

Most plans also use a network of doctors and hospitals. You’ll usually pay less by choosing providers in your plan’s network.

How can I compare plans?

Health insurers must provide a Summary of Benefits and Coverage (SBC) for each plan. It’s like a nutrition label for health insurance that makes it easier to compare your options.

It answers questions like:

What’s the overall deductible?

Is there a limit on out-of-pocket costs?

Does this plan use a provider network?

What services aren’t covered?

What type of coverage do I need?

If you’re insured through your employer, you may choose from a few group plans.

If you buy your own insurance, you can compare individual plans from a variety of companies.

Why choose a Primary Care Physician?

Your Primary Care Physician (PCP) is your partner in staying healthy.

They handle checkups, answer everyday questions, and refer you to specialists when needed.

When can I enroll in a health plan?

You can usually sign up for health insurance during open enrollment, which happens once a year.

If you miss that window, you may still qualify for a Special Enrollment Period if you’ve had a life change such as:

Losing other coverage

Getting married or divorced

Having a baby or adopting a child

Moving to a new ZIP code

Missed your enrollment window and need coverage now? A short term health plan might be a good option until the next open enrollment period.

Explore your options: Compare plans, check your enrollment window, or get help choosing a plan that fits your needs and budget.