There are a few things you or your family may want to know when choosing health insurance, such as:

  • Where you can get coverage
  • What plans are available to you
  • How to decide on a plan that might work for you

Where can I get coverage?

You might be able to get insurance from several places. You may have lots of options available to you or your family, but to get an idea of where to look, click on what best describes you:

Your job may offer Employer-Sponsored Insurance (ESI); however, some companies do not offer insurance

See what types of plans might be available

Employer-Sponsored Insurance (ESI) may be available through your spouse's employer

See what types of plans might be available

Your employer may offer health insurance, but if not, take a look at the Health Insurance Marketplace

See what types of plans are available

Talk to your parent or legal guardian to see if you are covered. If you are not, you may have to look for health insurance on your own, or through the Health Insurance Marketplace.

You and your family might want to look for health insurance on your own, or through the Health Insurance Marketplace. Talk to your parent or legal guardian about signing up for a plan that will cover your whole family, and together you can see what types of plans might be available.

Take a look at the Health Insurance Marketplace

See what types of plans might be available

Take a look at the Health Insurance Marketplace

See what types of plans might be available

You may be able to get coverage through Medicaid or other sources. Here are 2 places you can look:

Medicaid
See if you are one of the adults who qualify at Healthcare.gov or visit Medicaid.gov for more information
or
Health Insurance Marketplace
See what types of plans might be available

Medicare might be a good choice for you

See if you qualify

There are 2 places you should start looking:

Medicare
See if you qualify by visiting SocialSecurity.gov
or
Medicaid
See if you qualify by visiting Healthcare.gov

There are 2 places you can start looking:

Medicaid can cover children and families with low income
See if you qualify
or
The Children's Health Insurance Program (CHIP) covers children and, in some states, pregnant mothers
See what types of plans might be available

The Health Insurance Marketplace offers some special benefits
View insurance options at www.healthcare.gov

Some services are available from the Indian Health Service
Visit IHS.gov to learn more

There are 2 places you can start looking:

Veterans Health Administration (VA) if you are an active member of the military
Apply at VA.gov
or
TRICARE if you are retired from the military
Learn more at TRICARE.mil

What are some of the types of plans offered by employers and private insurers?

Private insurers and Employer-Sponsored Insurance (ESI) often have similar types of plans to choose from. While the actual plan names may be different, these are the most common types of plans offered. The type of plan may be included in the name, or it may be called something else, so be sure to ask your company's benefits manager or insurance company to help you understand your options.

All plans will have some things in common. For example, each plan has a monthly payment (called a premium) that you will pay even if you do not use health insurance that month. Most plans will cover basic care and prescription medicines, but you should review the list of covered drugs for your plan options to see what medicines are covered and how much they might cost you.

  • Health Maintenance Organizations (HMOs) are plans that generally require you to use providers (doctors and services) that they have selected (called a network)
  • Out-of-network coverage
    While these plans usually cover most or all of the cost of seeing doctors (or using other services) within their network, you may have to pay all of the cost out of your own pocket to use doctors and services that are not part of their network
  • Specialists/referrals
    To see a specialist, you will need a referral (like getting permission) from your primary care physician (PCP)
  • Exclusive Provider Organizations (EPOs) are similar to HMO plans and generally require you to use providers (doctors and services) that they have selected (called a network)
  • Out-of-network coverage
    While these plans usually cover most or all of the cost of seeing doctors (or using other services) within their network, you may have to pay all of the cost to use doctors and services that are not part of their network
  • Specialists/referrals
    You will likely not need a referral from your primary care physician (PCP) to see a specialist or for certain tests
  • Preferred Provider Organizations (PPOs) let you choose to get care from doctors and services within or outside of the plan's group of selected doctors (network)
  • Out-of-network coverage
    These plans will cover some of the cost if you decide to use doctors and services that are out-of-network, but you will pay more than if you had stayed in network
  • Specialists/referrals
    Most PPOs do not need referrals from your primary care physician (PCP) before you see a specialist
  • Like PPOs, Point-of-Service plans (POS) let you choose to get care from doctors and services within or outside of the plan's group of selected doctors (network)
  • Out-of-network coverage
    These plans will cover some of the cost if you decide to use doctors and services that are not on your plan's list, but you will pay more than if you had stayed in network
  • Specialists/referrals
    POS plans may require referrals from your primary care physician (PCP) before seeing a specialist
  • A high deductible health plan (HDHP) can be a PPO, POS, or HMO with a lower monthly cost (premium) but a higher amount you must spend before insurance will start to share the cost with you (deductible)
  • HDHPs may include options for a Health Reimbursement Arrangement (HRA) or Health Savings Account (HSA).
  • Out-of-network coverage
    HDHPs might count out-of-network services when trying to reach the deductible, or they might only count in-network services. They also might have differences in what is covered once you have reached the deductible, so be sure to check the plan details when choosing an HDHP
  • Specialists/referrals
    This depends on what type of HDHP you have (HMO, PPO, etc)
  • These plans also have high deductibles but have very little benefits
  • Like a safety net, these plans only cover services that are much more expensive, such as those related to a serious accident or illness
  • They have a lower monthly cost (premium) but a very high amount you must spend before insurance will start to pay (deductible)
  • You are eligible if you are under 30 or if you qualify due to financial hardship
  • These plans do cover 3 primary care physician visits per year and most include a number of free preventive services, like immunizations and health screenings for qualifying patients
    • Catastrophic plans do not cover medicines prescribed by your doctor, so you will pay the full cost
Why do I need health insurance?

What do all these terms and letters mean?

Use the glossary

What kinds of plans are available through the Health Insurance Marketplace?

If you are uninsured, your employer doesn't offer coverage, or you can't afford other insurance plans, you can find health insurance through the Health Insurance Marketplace. It is made up of private health plans, and when you use the Health Insurance Marketplace you may be able to get lower costs on your monthly premiums and out-of-pocket costs.

If you are self-employed or just prefer to have other options outside of your employer, you may also want to look at these plans. Just know that if your job offers health care, you might not be able to get financial assistance from the government.

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