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Understanding Your Health Insurance Plan

Understanding Your Helath Insurance Plan

It’s important to understand the type of health insurance you have 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


What Is My Insurance Plan?


Government Program:
  • Medicaid: You receive this free or low-cost health insurance coverage if you are eligible based on income or a disability.
  • Medicare: You have this insurance plan if you are 65 or older:

    (Part A covers hospital only; Part B covers regular doctor visits; Part C covers both based on purchasing a plan through a private insurance company; Part D covers prescriptions)


Private/Commercial:

Health insurance plans that are provided to you through your job or by purchasing them directly through an insurance company (ex:  Aetna, Blue Cross Blue Shield, Cigna, etc).

How Do I Know Which Type of Commercial Plan I Have?:

  • PPO (Preferred Provider Organization) - has lower co-payments but gives you more flexibility in selecting a provider
  • HDPD (High-Deductible Health Plan) - has a higher deductible than most health plans, but it has a lower monthly premium
  • HMO (Health Maintenance Organization) - has lower co-payments and covers the costs of more preventive care, but your choice of health care providers is limited to those who are part of the plan

Marketplace Exchange Plan:

You have this type of insurance if you purchased your plan through healthcare.gov



Key Insurance Terms You Should Know

Confirm these details prior to setting your doctor's appointment
TIP: Have the doctor's office verify your coverage prior to setting your appointment or contact the insurance company directly.

  • 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.


Links to Helpful Health Insurance Information

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


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