Why health insurance matters
Health insurance prevents a single emergency or chronic illness from wiping out your savings. It pays negotiated provider rates, covers preventive services, and can reduce overall cost of care. In the U.S., marketplace subsidies, employer plans, and government programs (Medicaid/Medicare) shape affordability and access.
Core terms to know
- Premium — monthly payment to keep coverage active.
- Deductible — amount you pay before insurance starts sharing costs.
- Copay/Coinsurance — fixed fee or percentage you pay for services after the deductible.
- Out-of-pocket maximum — annual cap on your spending for covered care.
Plan types: brief overview
Choose between network-driven plans (HMO, EPO), flexible access (PPO), and cost-saving options (HDHP paired with an HSA). Each balances premium vs. access differently.
Quick comparison
| Feature | HMO | PPO | HDHP+HSA |
|---|---|---|---|
| Premium | Lower | Higher | Lower |
| Referrals | Yes | No | No |
| Out-of-network | Limited | Often | Varies |
How to choose the right plan
Start by estimating annual utilization: number of doctor visits, prescriptions, specialist care, and expected procedures. Calculate an expected annual cost = (premium × 12) + expected out-of-pocket expenses (deductible + copays). If you expect high usage, a plan with higher premiums and lower deductibles often costs less in total.
Practical ways to save
- Check eligibility for ACA premium tax credits on healthcare.gov.
- Use HSA if eligible and contribute pre-tax.
- Pick in-network providers to avoid balance billing.
- Shop plans annually — networks and premiums change year to year.
FAQs
Are preventive services free?
Most marketplace and employer plans cover preventive services at $0 in-network (annual exams, immunizations, screenings).
Can I change plans mid-year?
Only during Open Enrollment or if you have a qualifying life event (marriage, birth, loss of coverage).
Compare Marketplace Plans & Subsidies
This article is informational only — not medical or financial advice.