Health insurance is a contract between an individual and an insurance company, where the insurer agrees to cover some or all of the individual's healthcare costs in exchange for monthly premiums. It helps protect against high medical expenses and provides access to preventive care, routine checkups, and emergency services.

• Health Maintenance Organization (HMO): Requires members to use a network of doctors and get referrals for specialists.

• Preferred Provider Organization (PPO): Offers more flexibility in choosing healthcare providers and doesn't require referrals.

• Exclusive Provider Organization (EPO): Similar to PPOs but with a more limited network.

• Point of Service (POS): Combines features of HMOs and PPOs.

• High-Deductible Health Plans (HDHPs): Lower premiums with higher deductibles, often paired with Health Savings Accounts (HSAs).

• Premium: The monthly fee paid to maintain coverage.

• Deductible: The amount you pay out-of-pocket before insurance starts covering services.

• Copayment: A fixed fee for specific services (e.g., $25 for a doctor's visit).

• Coinsurance: The percentage of costs you pay after meeting your deductible (e.g., 20% of a hospital bill).​

The Health Insurance Marketplace is a platform established under the Affordable Care Act (ACA) where individuals can compare and purchase health insurance plans. It also determines eligibility for subsidies and Medicaid.

• Open Enrollment Period: Occurs annually from November 1 to January 15.

• Special Enrollment Period: Triggered by qualifying life events like marriage, birth of a child, or loss of other coverage.​HealthCare.gov

Subsidies are financial assistance programs that lower the cost of premiums and out-of-pocket expenses. Eligibility is based on household income and size. For example, individuals earning between 100% and 400% of the federal poverty level may qualify.

Yes, under the ACA, insurance companies cannot deny coverage or charge higher premiums based on pre-existing conditions.

• In-Network: Healthcare providers contracted with your insurance plan, often resulting in lower costs.

• Out-of-Network: Providers not contracted with your plan, typically leading to higher out-of-pocket expenses.

COBRA allows individuals to continue their employer-sponsored health insurance after leaving a job, usually for up to 18 months. However, individuals must pay the full premium plus a small administrative fee.

• Coverage Needs: Assess your medical needs and those of your family.

• Costs: Evaluate premiums, deductibles, copayments, and coinsurance.

• Provider Networks: Ensure your preferred doctors and hospitals are in-network.

• Prescription Coverage: Check if your medications are covered.

• Additional Benefits: Look for plans offering dental, vision, or wellness programs.