• You have a health issue.
• You visit your doctor.
• Your insurance provider reimburses your doctor.
• Or your doctor bills your insurance provider.

• Deductible – The amount you pay each year to cover eligible medical expenses.
• Co-pay – A flat fee for certain medical expenses.
• Co-insurance – A percentage that you pay to share the cost of covered services with your insurance after your deductible has been paid.
• Premium – The amount you pay for your health plan every month.
• Out-of-pocket max – The max amount you will pay a year for coverage.
• Essential benefits – All plans include services such as ambulatory patient services, emergency services, hospitalization, maternity and newborn care, and more.

HMO- – Short for health maintenance organization. Most restrictive. Requires you to choose a primary care physician from their provider networks. If you go out of network, you have to pay all medical costs.

PPO – Short for preferred provider organization. It’s a type of health insurance arrangement that allows plan participants relative freedom to choose the doctors and hospitals they want to visit. Most flexible. You won’t be required to stay in-network for health care like with HMO and you do not have to use a primary care physician. You can go out of network for care, but you will receive less coverage.

POS – Short for point of service plan. It’s a type of managed care health insurance plan. It combines characteristics of the health maintenance organization (HMO) and the preferred provider organization (PPO). The POS is based on a managed care foundation—lower medical costs in exchange for more limited choice. You must choose a primary care physician and you can go out of network and still receive insurance coverage. Out-of-pocket expenses are higher if you do not get referrals for non-network care.

EPO – Short for exclusive provider organization. As a member of an EPO, you can use the doctors and hospitals within the EPO network, but cannot go outside the network for care. There are no out-of-network benefits. You must choose a primary care physician and you can go out of network and still receive insurance coverage. Out-of-pocket expenses are higher if you do not get referrals for non-network care.

4 Reasons to have health insurance:

Illness – Health insurance covers the cost of treating unexpected illnesses.

Bills – Health insurance protects you from high medical costs that could potentially lead to bankruptcies.

High cost – You pay less for covered in-care network health care.

Penalties – You won’t have to pay tax penalties.

Medicare is the federal health insurance program for people who are 65 or older.

A Medicare Supplement Insurance (Medigap) policy, can help pay some of the health care costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles. Medigap policies generally don’t cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.