All About Health Insurance: A Guide for Consumers

Having health insurance usually means you pay a premium every month and, in return, your health plan pays part of the bill when you need a service from a doctor or another provider to keep you healthy or treat a disease. Health insurance usually covers doctors' visits, prescription drugs, medical, and surgical services.

There are several different ways to get health insurance. Some people buy coverage on their own. Many people get coverage through their job or a family member's job. Others are covered through public programs like Medicare and Medicaid. State insurance regulators provide oversight for some of these types of health insurance. Different regulatory agencies have responsibility for other types of coverage. Explore the ways to get health coverage below.

Individual Market—Buying Health Insurance on Your Own

When you or your family purchase health insurance and are not part of a group that gets health coverage together (like an employer), you're considered to have 'individual market' coverage. Many people choose to buy individual market coverage through a health insurance marketplace, either Healthcare.gov or their state's marketplace. Buying through a marketplace allows those who qualify to get premium tax credits to help with the cost of their coverage. An insurance agent or broker can help you choose an individual market plan, or your state may have health insurance 'navigators' or other community-based assisters to help you.

While marketplaces only offer health insurance (and dental coverage) that meets certain requirements for benefits and coverage, other types of health insurance are also available to purchase on your own. These other types of insurance cover a more limited set of health care services and may choose not to cover you or charge you more if you have a pre-existing health condition. See a list of Other Types of Health Insurance below.

State insurance regulators help enforce consumer protections and other insurance laws for individual market insurance in their states. To find out how to contact your state's insurance commissioner, see the Members section.

Other Types of Health Insurance

Short-Term, Limited Duration Insurance

This insurance covers some of the same types of services as comprehensive health insurance but is not required to offer a full set of essential health benefits. The plans typically cover a smaller share of the cost of services than comprehensive health insurance. That means you may pay less in premiums, but enrollees pay more when they need health care services. The plans may deny applicants or charge them more if they have pre-existing health conditions.

Basic Hospital Expense Coverage

This insurance covers a period of usually not less than 31 days of continuous in-hospital care and certain hospital outpatient services.

Basic Medical-Surgical Expense Coverage

This insurance covers costs associated with a necessary surgery, including a certain number of days of in-hospital care.

Hospital Confinement Indemnity Coverage

This insurance pays a fixed amount for each day that you are in a hospital.

Accident Only Coverage

This pays a lump sum when the enrollee experiences death, dismemberment, disability, or hospital and medical care caused by an accident.

Specified Disease Coverage

This insurance covers diagnosis and treatment of a specifically named disease or diseases, such as cancer.

Long-term Care Insurance

Long-term care insurance usually pays for skilled, intermediate, and custodial care in a nursing home, as well as care in other settings, such as the home, adult day care center, or assisted living facility. The policy usually pays a fixed amount per day while a person is receiving care.

Other Limited Coverage

You may purchase insurance covering only dental or vision or other specified care.

Employer-based Coverage

Most nonelderly Americans get health care coverage through employment, either through their own job or a family member's. Employees and their families usually have a chance to sign up for coverage when starting a new job and once each year during an enrollment period.

State insurance regulators help to oversee insurance plans that employers purchase, often when the employer has fewer than 50 employees. But many employers choose to ‘self-insure' rather than purchase health insurance. The U.S. Department of Labor generally provides oversight of self-insured employer plans. Other agencies, including the Office of Personnel Management, the Defense Health Agency, and the Centers for Medicare and Medicaid Services, provide oversight when the employer is a government agency.

Public Coverage

Many people get health coverage through public programs like Medicare, Medicaid, and the Children's Health Insurance Program.

The federal Medicare program pays most medical expenses for people age 65 or older and for individuals under 65 receiving Social Security disability benefits. However, Medicare does not pay all expenses. As a result, some Medicare-eligible individuals choose to buy a Medigap policy that helps pay for certain expenses, including deductibles not covered by Medicare.

Medicaid and the Children's Health Insurance Program are administered by states. Here's a list of contacts for each state.