Figuring out what coverage you are eligible for is the first step in obtaining health insurance.
Find out if you can gain coverage through your employer or if you can be placed on your spouse’s or parent’s plan. About 55 percent of Americans have an employer-sponsored plan while another 10 percent buy it on their own, according to the U.S. Department of Health and Human Services (HHS).
Figure out if your income, age or other factor, such as a disability, makes you eligible for a state or federal health plan. For example, the federal Medicaid program is designated for those with low incomes and children while Medicare covers people over 65 and certain people under 65 with a disability.
See the sections below for specific guidance from a state/district level.
- District of Columbia
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- Maryland
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- Virginia
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- Helpful Insurance Terms for You to Know
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Here are some of the most common terms you will encounter when selecting and using health insurance:
Premium: the amount you and/or your employer pays for health insurance. It can be paid monthly, quarterly or yearly.
Deductible: the amount of money that must be paid out-of-pocket for a health care service before an insurer will start to pay
Co-payment: fixed amount you pay when receiving a health service, such as a doctor visit or to receive prescription drugs
Co-insurance: the percentage an insured person pays for a service after a deductible is met. Your insurance pays the rest.
Network: the hospitals, physicians and other health care providers your insurance has contracted with to provide health care services.
HMO (health maintenance organizations): managed care plans that have a closed network of providers you can visit. Most HMOs require you to have a primary care physician who will refer you to a specialist if needed.
PPO (preferred provider organization): managed care plans that allow you to visit any doctor from a preferred network of hospitals and physicians. Under PPOs, you can visit a doctor out-of-network, but you will be charged more.
Out-of-network: health care providers not contracted to provide services to customers on a particular health plan.
Out-patient: a person who visits a hospital or clinic for medical services but does not require an overnight stay.
Inpatient: a person who is admitted to a hospital for at least one night for ongoing care.
More Complete Lists of Health Insurance Terms
- eHealth Insurance, a licensed health insurance agency, offers a Health Insurance Glossary.
- HealthCare.gov has a glossary of insurance terms.
- Healthinsurance.org, an independent internet website, provides a Health Insurance Glossary.
Original post by the Center for Advancing Health. Updated by the GW Cancer Center July 2024.