Health Insurance Basics: What You Need to Know

Knowledge is crucial to health insurance, from understanding premiums and deductibles to taking advantage of the best health coverage possible. This guide will provide a basic understanding of how health insurance works, common terminology, and the different types of plans available. It’s important to remember that not all health insurance plans are created equal, and your best plan will depend on your needs.

About Health Insurance

Health insurance is a form of financial savior that helps cover medical care costs. It can allow you to access quality healthcare services without paying out-of-pocket costs. Some common exclusions include cosmetic surgery, experimental treatments, or certain pre-existing conditions. Make sure you know about any waiting periods or coverage limits.

Different Types of Health Insurance

There are a few types of health insurance plans to choose from:

  • Health Maintenance Organization (HMO): With HMOs, you pick a main doctor (your go-to person) and need their okay to see specialists. They often have lower monthly costs but fewer choices in doctors.
  • Preferred Provider Organization (PPO): PPOs give you more freedom to choose doctors without referrals. They usually cost more monthly but save you money if you stay in their network.
  • Exclusive Provider Organization (EPO): These plans are like PPOs but won’t cover out-of-network care except for emergencies.
  • Point of Service (POS): POS plans mix HMO and PPO features. You have a main doctor, but you can see specialists without needing a referral, though it may cost a bit more.

Pay Attention to Premiums, Deductibles, and Copayments

  • Premium: This is the amount you contribute each month to maintain your insurance, similar to a subscription fee, regardless of whether you use it.
  • Deductible: Think of this as your healthcare threshold. You pay up to a certain amount for medical stuff, and the insurance starts helping. Usually, higher deductibles mean lower monthly premiums.
  • Copayment (Copay): You chip in for certain medical services, like seeing your doctor or getting meds. It’s a set amount, just like a doctor’s visit.

In-Network vs. Out-of-Network

Most plans have a group of doctors and hospitals they work with (in-network). Sticking with them often costs you less. Going to someone outside the network (out-of-network) can be pricier, and your insurance might cover less.

Signing Up at the Right Time

Health insurance plans have specific times when you can sign up:

  • Open Enrollment: This happens once a year. It’s when you can pick a new plan or make changes to the one you have.
  • Special Enrollment Periods (SEPs): SEPs let you enrol outside the regular open enrollment if you’ve had specific life changes like getting married, having a baby, or losing a job.


  • Health insurance, while a bit complex, is a vital part of our lives.
  • Understanding the details of health insurance allows you to make informed decisions about your healthcare.
  • Take the time to review your policy and don’t hesitate to ask questions.
  • Remember that prioritizing your health is an investment in a healthier and financially secure future.