Understanding health insurance

What is health insurance?

What is health insurance exactly? It’s talked about a lot — but how does it really work and why do we need it? Here’s a simple way to look at it: Health insurance is a plan, or policy, that covers a percentage of doctors’ visits and hospital bills. It exists to help offset the costs of medical events, whether they’re planned or happen unexpectedly. Health insurance may also protect us when we’re feeling good — and may help keep us feeling that way — through wellness programs and preventive care.

Even if you’re the picture of good health right now, you never know when you’re going to need health insurance. A car accident, an injury, a cancer diagnosis — those don’t come with warnings. Not having health insurance is a risk, not only for the preservation of your health, but also your financial security.1

How does health insurance work?

Health insurance is a contract between you and your insurance company/insurer. When you purchase a plan, you become a member of that plan, whether that’s a Medicare plan, Medicaid plan, a plan through your employer or an individual policy, like an Affordable Care Act (ACA) plan.

There are many reasons to have health insurance. One reason is that it may give you peace of mind that you’re covered in case unexpected medical expenses happen. Knowing the details of how health insurance works can be an advantage when you’re deciding which plan is right for you.

What are the different types of health insurance?

There are different types of health insurance plans to fit different needs. Some types of health insurance include government plans like Affordable Care Act (ACA) plans — which can also be called Marketplace or Exchange plans — Medicare plans and Medicaid plans. Before you choose a plan during open enrollment, it may help to review the various types of plans to get a better understanding of which type of health insurance may work best for you.

Health insurance open enrollment

Open enrollment is a special period of time when you get to start, stop or change your health insurance plan. This period most often happens once a year (unless you undergo a qualifying life event). There are different enrollment periods depending on if you have insurance through your employer, Medicare or an ACA plan.

Understanding health insurance costs

Having insurance doesn’t mean your health care will be free. You’ll still pay a monthly rate, or premium. Members may also pay copayments — or other out-of-pocket fees — or have to meet deductibles every year before insurance coverage kicks in.

Different factors can affect your health insurance costs. It’s important to understand what these costs are before selecting a plan.

Common health insurance terms

Deductibles, premiums, network, claims, benefits — what do all these words actually mean? Health insurance practically seems to have a language of its own. To make it easier, you can check out our list of common terms and get quick definitions that help explain what they mean — in everyday language.

Footnotes

  1. Health coverage protects you from high medical costs | healthcare.gov