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Health Insurance Basics

Health insurance is a way to help pay for health care expenses. Having insurance helps in the event of an accident or illness by paying some of the medical costs when you're injured or sick. Like car insurance or home insurance, you can choose from a variety of plans.

How insurance works

When you have health insurance, the insurance company pays a portion of your medical expenses. The amount the insurance company will pay, and the services that are covered (coverage) varies by plan.


For example...

You may have to pay a $20 co-payment for each doctor visit. Or, the plan may not cover anything until you've paid a certain amount (the deductibles ). These deductibles and co-payments , along with any other expenses you may pay, are referred to as out-of-pocket expenses.

Some plans may also have co-insurance , which is the percentage of the bill that you're required to pay, in addition to your deductible and co-payment.

The term cost-sharing  is often used to describe the share of costs covered by your insurance that you pay out of your own pocket. This generally includes deductibles, co-insurance, and co-payments, but it doesn't include premiums, balance billing amounts for non-network providers, or the cost of non-covered services.

The amount you pay each month for your coverage is the premium .

$$$
Premium
$$$
Deductible
$$$
Premium
$$$
Deductible

Generally, the higher your monthly premium, the lower your deductible will be.

The relationship between premium and deductible

No matter which health insurance plan you choose, you’ll pay a monthly payment (your premium) to keep your health insurance coverage. You may also pay a certain amount (co-payment or co-insurance) each time you receive medical care.


Common Terms used in Health Insurance

Need help with the lingo? You don’t need to learn a whole new language, but here’s a list of some terms you are likely to see as you review health insurance information.

It’s all about the metals

To make it easier for people to shop for and compare health insurance plans in the Health Insurance Marketplace, the plans are separated into 4 “metallic” categories based on how you and the plan are expected to share the costs of essential health benefits.

Bronze

Bronze

Monthly Premium
(Lowest)
Cost Per Visit/Prescription
(Highest)
Avg. % of Essential Health Benefits Plan Pays
60% (in network)
Avg. % of Essential Health Benefits You Pay
40% (in network)
Best If You...
Rarely use medical services. Want to save money and do not expect to use many medical services.
Silver

Silver

Monthly Premium
(Low)
Cost Per Visit/Prescription
(Moderate)
Avg. % of Essential Health Benefits Plan Pays
70% (in network)
Avg. % of Essential Health Benefits You Pay
30% (in network)
Best If You...
Want to balance monthly premium costs with out-of-pocket health expenses.
Gold

Gold

Monthly Premium
(Moderate)
Cost Per Visit/Prescription
(Low)
Avg. % of Essential Health Benefits Plan Pays
80% (in network)
Avg. % of Essential Health Benefits You Pay
20% (in network)
Best If You...
Willing to pay more in monthly premium costs to reduce out-of-pocket health expenses.
Platinum

Platinum

Monthly Premium
(Highest)
Cost Per Visit/Prescription
(Lowest)
Avg. % of Essential Health Benefits Plan Pays
90% (in network)
Avg. % of Essential Health Benefits You Pay
10% (in network)
Best If You...
Expect higher use of medical services and want to reduce out-of-pocket health expenses.

The plans in all 4 categories offer the same set of essential health benefits and the relative costs represented here are guidelines only, actual costs may vary. The difference is in how much help you want paying for things like hospital visits or prescription medications. That’s why it’s important to evaluate plan options when choosing the plan that’s right for you and your family.

Have questions?

We've got answers.

Small Business Tax Credits

(resulting from the Affordable Care Act)

If you are a small business and all of the following apply to you, then there may be a tax credit that will put money back in your pocket.

Do you...

Have less than 25 full-time equivalent employees?

Pay an average annual wage of less than $50,000 (as adjusted for inflation beginning in 2014)?

Pay at least 50% of your employees health insurance premiums?

To learn more about how to file the required documents, please visit   IRS.Gov - Small Business Health Care Tax Credit for Small Employers.

Ready to try it out?

Create a perfect fit benefits package in just a few minutes.

Offer your employees options, and control your costs.

It's unlikely that a single health plan can fit everyone's needs so why not let them choose their own coverage? With Multi-Choice your small business can offer several plans to choose from without taking on extra cost. Employees get control over their health coverage, your business gets controlled costs.