Why Health Insurance Matters
Health insurance is one of the most important financial protections you can have. A single hospital stay can cost tens of thousands of dollars, and even routine medical care adds up quickly without coverage.
Key Terms You Should Know
Premium
The amount you pay monthly to maintain your health insurance coverage, regardless of whether you use medical services.
Deductible
The amount you pay out-of-pocket before your insurance begins covering costs. For example, with a $2,000 deductible, you pay the first $2,000 of covered services.
Copay
A fixed amount you pay for a specific service, like $25 for a doctor visit or $15 for a prescription.
Coinsurance
Your share of costs after meeting your deductible, expressed as a percentage. For example, with 20% coinsurance, you pay 20% and your insurer pays 80%.
Out-of-Pocket Maximum
The most you'll pay in a year for covered services. Once you hit this limit, your insurance covers 100% of remaining costs.
Types of Health Plans
HMO (Health Maintenance Organization)
- Requires a primary care physician (PCP)
- Need referrals for specialists
- Lower premiums, smaller networks
- Best for: Budget-conscious individuals who don't mind network restrictions
PPO (Preferred Provider Organization)
- No referrals needed for specialists
- Larger provider networks
- Higher premiums, more flexibility
- Best for: People who want freedom to choose providers
EPO (Exclusive Provider Organization)
- No referrals needed
- Must stay in-network (except emergencies)
- Moderate premiums
- Best for: People who want flexibility without high PPO costs
HDHP (High Deductible Health Plan)
- Higher deductibles, lower premiums
- Can be paired with an HSA (Health Savings Account)
- Best for: Healthy individuals who want to save on premiums
The ACA Marketplace
The Affordable Care Act (ACA) marketplace offers plans categorized by metal tiers:
- Bronze: Lowest premiums, highest out-of-pocket costs
- Silver: Moderate premiums and costs (subsidy-eligible)
- Gold: Higher premiums, lower out-of-pocket costs
- Platinum: Highest premiums, lowest out-of-pocket costs
Tips for Choosing the Right Plan
- Estimate your annual healthcare usage
- Check if your doctors are in-network
- Review the prescription drug formulary
- Calculate total annual costs (premiums + expected out-of-pocket)
- Consider your risk tolerance
We're Here to Help
Choosing health insurance doesn't have to be stressful. Contact our licensed agents for a free, no-obligation consultation. We'll help you find the right plan for your needs and budget.