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Health Insurance Basics – All you need to Know About

Health insurance is designed to protect you and your family from the cost of medical services you may need in the event of illness or injury. You choose a plan and agree to pay a certain premium each month. Your insurer then agrees to pay a portion of the costs you incur. These payments are usually based on discounts that health insurers negotiate with doctors or hospitals.

Why do I need insurance?

No one plans to get sick or injured, but illnesses and injuries can happen at any time. In some cases, they can wreak havoc on your health and leave you with high medical bills. Health insurance limits your risk of having to pay for very expensive illnesses and injuries by covering medical care and other services such as hospitalization and surgery.

Health insurance also helps you protect your health and well-being, especially by covering preventive services.

Reasons to buy health insurance

How do health insurance benefits work?

You choose a health insurance plan based on the cost of the plan and the services and benefits it covers. With most health insurance plans, you pay a fixed amount each month called a premium. You can get fast health insurance quote to know the plans. In addition to your premium, you may also pay each time you use medical services or fill a prescription. These payments are often called cost-sharing or out-of-pocket costs and can be divided into the following types:


A deductible is the amount you must pay each year before your health plan will pay for covered services. For example, if your plan has a $1,000 deductible, you must pay the first $1,000 of the cost of health care services you use in a given year. Once you've paid that amount, your insurance will cover some or all of your health care costs, depending on your plan.


A copayment is a flat fee you pay when you see a doctor or use other services. For example, you pay $20 for a doctor's visit.


A coinsurance is the percentage you pay for certain covered services. If your coinsurance is 20 percent, your health plan pays 80 percent of the cost of covered services. You pay the remaining 20 percent yourself - your cost is usually based on a discount amount negotiated by your health insurance company.

Maximum copay

An out-of-pocket maximum is the maximum amount you must pay during a coverage period (usually one year) for the cost of medical care at providers who participate in the plan's network. In no case will you pay more than this maximum amount in any given year. Any services you receive after the maximum amount is reached will be covered 100% by your insurance plan.

How to purchase private insurance

If you do not have insurance through your employer or are not eligible for financial assistance through a government-funded program, you will likely need to purchase private individual or family insurance through a private health insurance provider like Insurance & You.

Buying private health insurance is much easier if you know what questions to ask. When it comes to health insurance, everyone has different needs and preferences. We can help you figure out what type of insurance you want, how to balance cost and coverage, and what other benefits you should consider.

How do I choose the right plan?

Understanding the features of a health insurance plan can help you choose the right plan. There are two factors to consider:

Freedom of choice/flexibility

Is it important to you that you can see doctors out of network or without a referral? If so, you should choose a PPO plan. If that's not as important to you, you should opt for an HMO plan - you choose a primary care physician to coordinate your care and can choose from a network of providers.


Are you trying to save money on health care costs? Then you should choose a plan with a higher deductible that can be used in conjunction with a health savings account to save tax-free amounts for qualified medical expenses. You save money when you see certain doctors and hospitals. This works best if your providers are already in the lowest cost category or if you don't mind switching providers. Finally, be sure to choose a plan with additional cost-saving benefits. Find out about all the exclusive programs, benefits, discounts and offers our member plans offer.

Gold, silver, bronze or catastrophic coverage.

The best way to purchase cheap health insurance is to get an overview of the individual and family plans available. The Affordable Care Act requires that all plans be structured according to the amount of coverage. Catastrophic coverage plans are also available for those under age 30 or those who qualify for a special exemption. All plans cover the same basic health benefits - the differe

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