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Health Insurance Basics

As with any big purchase, you want to feel good about the health coverage you choose. Here are some things to think about as you set out to find a health plan that‘s right for you.

How health care coverage works

The amount you pay monthly is called your premium. Then, when you get care throughout the year, most health plans work in three ways:

  1. You pay your deductible, a set amount that you pay each year before your plan starts paying for covered services. If you choose a plan with copay along with a deductible, you only need to pay the copay for most doctor visits.
  2. After you meet your deductible, you and your plan share the cost of covered services. You pay a copay or coinsurance each time you get care. Your insurance covers the rest.
  3. You‘re protected by your out-of-pocket limit. That‘s the most you pay for covered health services each year. And even before your deductible, our plans cover checkups and certain types of preventive care at no cost to you.

The Basics of Health Insurance

Watch a video on the basics of health insurance. This short, interactive video will help you better understand how your health plan works.


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Things to consider when buying health insurance

  • Your situation. Who‘s getting covered? Is it just you or do you need family coverage?
  • Your health. Are you pretty healthy? Do you go to the doctor a lot? How much do you think you‘ll need?
  • Your doctor. Do you already have a main doctor you like and trust? As you‘re shopping, you‘ll be able to check if your doctor is in a plan‘s network of doctors.
  • Your budget. How much can you pay for a plan?
  • Financial help. You may qualify for a subsidy. That‘s money the government gives you toward the cost of your health plan. Once you start shopping, use our Subsidy Estimator to see if you qualify.


Shopping Guide

Watch a video created as a guide to shopping for health insurance. It's short, interactive and could be that extra help you need to find a health plan that's right for you.

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Different kinds of health insurance plans and networks

Different types of health insurance plans meet different needs. When you compare options, it‘s important to understand some of the ways plans are structured.

  • Higher deductibles. If you think you won‘t use that much health care next year, you could get a plan that may cost less per month with a higher deductible. And we also cover some of the basics at no extra cost — like checkups and other preventive care.
  • Higher copay or coinsurance. Some plans cost less monthly, but then pay slightly less of your care costs. Depending on your situation, this could save money over the course of a year. And you still get checkups and other preventive care at no extra cost.
  • Choice of doctors and hospitals.. Some health plans may cost less because they give you a smaller group of doctors and hospitals to choose from. These plans may be a perfect fit if you aren‘t settled on a particular doctor yet — or if your doctor is already in that plan‘s network (also called an in-network doctor). And you can feel confident you‘ll get quality health care from the doctors and hospitals in your plan.
  • Health Maintenance Organization (HMO). This type of health plan only covers services from a network of doctors in your area. With some HMO plans, you‘ll need to choose a main doctor, also called a primary care physician (PCP), from the HMO network. Your PCP helps you manage your care. If you need a specialist, you‘ll most likely have to go through your primary care doctor to get a referral.
  • Preferred Provider Organization (PPO). These insurance plans give you a choice of getting care within or outside of a provider network. You may use out-of-network providers and facilities, but you‘ll have to pay more than if you use in-network ones. If you have a PPO plan, you can visit any doctor without a referral.
  • Catastrophic plans.. People under 30 and people with certain financial limitations may buy a "catastrophic" health plan. It‘s called catastrophic because it protects you if you end up with some really large medical costs due to an unexpected illness or accident. These plans often require that you pay all of your medical costs up to a certain amount, usually several thousand dollars — although some also cover some preventive care like checkups.

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Consider adding Dental & Vision coverage

When you‘re shopping for a health plan, consider adding Dental & Vision coverage. Besides helping you keep a great smile, regular dental check-ups can help find early warning signs of health issues. That‘s one really good reason to take excellent care of your teeth and gums. And dental coverage from Anthem can help make it easy and affordable.

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Find out if your prescription drugs are covered

Most of our health plans have pharmacy coverage as well. That‘s because prescription drugs can be an important part of the care your doctors give you. When you‘re comparing plans using our online shopping tool, you‘ll be able to look at some background information on the types of drugs these plans cover.

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