Medicare is a federal program primarily for individuals aged 65 and older, providing coverage for hospital care, medical services, and prescription drugs.

Medicaid is a joint federal and state program aiding low-income individuals and families, offering comprehensive health coverage based on eligibility criteria.

Employer-based coverage is insurance offered and often subsidized by your employer, typically as part of a group plan with multiple options. These plans usually cover large groups of 50+ employees.

“Private” Health Insurance - Generally speaking, is anything else other plan that is not government-subsidized or government-partnered.

VA Healthcare, provided by the Department of Veterans Affairs, is a comprehensive health care system for eligible veterans.

This is the amount you pay each month for your health insurance, regardless of whether or not you use medical services.

This is the amount you pay out-of-pocket for health care services before your health insurance begins to pay.

This is the most you'll have to pay during a policy period for your share of the costs of covered services.

Co-payment is a fixed amount you pay for a covered healthcare service, while co-insurance is your share of the costs of a healthcare service.

In-network healthcare providers have contracted with your insurance company to provide services for less than their usual fees. If a doctor is out-of-network, you may pay more.

HMOs (Health Maintenance Organization) prioritize lower costs and coordinated care within a limited network.  

PPOs (Preferred Provider Organization) prioritize greater flexibility and choice of providers, even if it means higher costs.  

FURTHER DETAIL:

HMO (Health Maintenance Organization): Network:

Limited; in-network care required (except emergencies).

PCP: Required; coordinates care and provides referrals.

Costs: Lower premiums and out-of-pocket costs.

Flexibility: Less choice of providers.

PPO (Preferred Provider Organization):

Network: Larger; in- and out-of-network options (out-of-network costs more).

PCP: Not required; no referrals needed.

Costs: Higher premiums and out-of-pocket costs.

Flexibility: Greater choice of providers.

Not all plans cover the same drugs, so it's essential to check this if you're on medication. What happens if I am prescribed a medication that is a brand name that no insurance covers?

Preventative care like vaccinations and screenings can help you stay healthy and catch health problems early when they are easier to treat.

Some plans require a referral from a primary care doctor before you can see a specialist.

Understand how the plan covers accidents and emergency room visits and whether you can go to any hospital or only those in your insurance network.

Some health insurance plans include coverage for dental and vision care, while others do not.

Some plans have specific terms or waiting periods for pre-existing conditions.

Is there a possibility that the insurance provider might terminate my coverage after a specific period?

It's important to understand the level of personalized attention and customer support you can expect from your plan.