Coverage guide
Health Insurance
Health insurance plans use premiums, deductibles, copayments, coinsurance, networks, and out-of-pocket maximums to define how covered medical costs are shared.
What it covers
- Preventive care
- Doctor visits
- Hospital care
- Prescription drugs
- Emergency care
- Mental health services
Who commonly researches it
- Individuals and families
- People between jobs
- Self-employed workers
- People aging out of dependent coverage
When people commonly buy
- During open enrollment
- After a qualifying life event
- When starting a new job
Coverage considerations
- Network access matters
- Premium is only one cost
- Check deductible, copays, coinsurance, and out-of-pocket maximum
Common exclusions
- Out-of-network services beyond plan rules
- Non-covered drugs
- Experimental services
- Services without required authorization
Cost factors
- Plan category
- Network
- Age and rating area
- Subsidy eligibility
- Household size and income
Comparison checklist
- Check annual premium
- Compare deductible
- Review drug formulary
- Confirm doctors and hospitals
- Estimate worst-case in-network cost
FAQ
What is an out-of-pocket maximum?
It is the most you pay for covered in-network services in a plan year, after which the plan pays 100 percent of covered benefits, subject to plan rules.
Do premiums count toward the deductible?
No. Premiums are paid to keep coverage active and generally do not count toward the deductible.