Understanding Health Insurance Plan Options

It’s important to understand the type of health insurance options that are available and your plan details before you go see a doctor so you are aware of what providers you can see and if there are any out-of-pocket expenses that may be required for the health care services you will be receiving.



 TIP: Have your health insurance card available when you contact a doctor's office to make an appointment
Type of Insurance Plans

Government Plans:

  • Medicaid: You receive this free or low-cost health insurance coverage through the state if you are eligible based on income or a disability [SOURCE: HHS.gov]
  • Medicare: Health insurance for people 65 or older, certain people under 65 with disabilities, and people of any age with End-Stage Renal Disease (ESRD). You can receive coverage through the federal government and/or supplemental plans through private insurance companies: (Part A - Hospital insurance; Part B - Medical insurance; Part C covers both based on purchasing a plan through a private insurance company; Part D - Prescription Drug Coverage [Source: CMS.gov] 
  • Dual Eligible Special Needs Plans (D-SNPs): Plans for individuals who are entitled to both Medicare and medical assistance from a state plan under Medicaid. States cover some Medicare costs, depending on the state and the individual’s eligibility. [Source: CMS.gov] 
Private/Commercial:
Health insurance plans that are provided to you through your job or school, or by purchasing them directly through an insurance company

  • PPO (Preferred-Provider Organization) - Larger doctor network, have to stay in doctor network, don't need referral, higher premiums & deductibles
  • HDHP (High-Deductible Health Plan) - Lower premiums, employer-contributed Health Savings Account, high deductibles
  • HMO (Health Maintenance Organization) - Lower premiums, lower costs than PPO, have to stay in doctor network, need referral to see a specialist 
More info

[SOURCE: Insurance.com]

Health Insurance Marketplace (healthcare.gov):
Another option for enrolling in a health insurance plan based on your qualifications

  • A service available in every state that helps individuals, families, and small businesses shop for and enroll in affordable medical insurance.
  • The Marketplace is accessible through websites, call centers, and in-person assistance.
  • When you fill out a Marketplace application, you’ll find out if you qualify to save money when you enroll in a medical insurance plan. You’ll also find out if you qualify for Medicaid and the Children’s Health Insurance Program (CHIP).
  • Whether you qualify for these programs depends on your expected income, household members, and other information
More info

[SOURCE: Healthcare.gov]

Key Insurance Terms

  • Co-Pay: what you pay each time you visit a provider. Visits to PCPs usually cost less than specialists.
  • Coinsurance: The percentage of medical costs you'll have to pay after you reach your deductible – ex: if your coinsurance is 20% and your doctor visit is $100, you will be liable for paying $20 for your visit.
  • Deductible: annual amount you'll have to pay out-of-pocket for your medical expenses before the insurance company begins to pay claims – if you have not reached your deductible amount for the year, you will have to pay for health care services.
  • HSA (Health Savings Account): an extra feature of your insurance plan in which you contribute pre-tax money to this account to go toward your healthcare expenses; you should always check the available funds in your HSA prior to making a doctor’s appointment.
 TIP: Have the doctor's office verify your coverage prior to setting your appointment or contact the insurance company directly.

Helpful Links

My Health Coverage at a Glance

Use this simple form to document the details of your health insurance: View Document

How To Get Health Coverage

View this list of options available for getting health care coverage: Learn More

Types of Marketplace Plans

Description of plan categories and types offered through healthcare.gov: View Plan Categories | View Plan Types