Staying proactive is an essential part of your overall health. The same is true for your health insurance. As time passes and your needs change, understanding the basics of coverage will help you pick the best plan for each moment.

Read on to learn about key terms, helpful resources, and how to choose the right plan. 

What Is Health Insurance?

In the United States, health insurance is an insurance product that covers some or most of the necessary health care costs should you become ill and require treatment. You will pay an insurer or health plan a variety of fixed and variable fees/copays. In turn, they will pay the health care providers who serve you.

Health insurance is available through both government programs and private companies. Usually, your employer will offer health insurance. Those who meet specific age and/or income requirements may be eligible for state or federally subsidized coverage like Medi-Cal. Also, seniors who qualify for Medicare should apply prior to their 65th birthday. Individuals who are permanently disabled may qualify as well.  

For families, children are eligible for coverage under a parent’s health plan until they turn 26 years old. 

Key Terms

Here are the common phrases you should know when navigating health insurance: 

• Open Enrollment — A specific period each year when you can sign up for health insurance or make changes to your existing plan. This year, Open Enrollment begins November 1 and ends January 15, 2025. 
• Medicaid — A jointly-run program between the federal government and states that helps with medical costs for some individuals beneath specific income levels.
• Medi-Cal — California's Medicaid program. Medi-Cal recently expanded its eligibility to many California residents 26-49 years old, regardless of their immigration status. To learn more, click here.  
• Medicare — A federal health insurance program for people 65 and older or younger people with disabilities. 
• Private Insurance — Health insurance provided by non-governmental organizations, usually through employers or purchased individually. 
• Premium — The amount you pay monthly to maintain your health insurance coverage.
• Copay — A fixed amount you pay for covered health care services, usually at the time you receive them (for example, a doctor’s visit). 
• Deductible — The amount you must pay out-of-pocket before your health insurance begins to cover certain services. At the end of your policy year, the deductible resets. 
• Coinsurance — Your share of the costs of a health care service, calculated as a percentage of the total cost, after you have paid your deductible. For example, a $100.00 service with a 10% coinsurance means you’ll pay $10.00, so long as the deductible has been reached. 
• Network — The group of doctors, hospitals, and other health care providers that your insurance plan has contracted with to provide you care at lower rates. 
• Out of Pocket Maximum — The maximum total you must pay for covered services in a year. After you reach this limit, your insurance pays 100% of any additional costs. As with a deductible, the out-of-pocket maximum resets at the end of each policy year. 

How to Choose the Right Plan

Your health requirements will change as you age or at each stage of life. To find compatible health plan, remember the following:

• Know Your Needs — Think about how often you visit the doctor, your prescriptions, and any ongoing health issues. 
• Compare Plans — Look at different plans and compare the costs like premiums, deductibles, and which doctors or hospitals are included. If you need frequent checkups due to a health concern, a higher-tier plan may be worth the cost.
• Get Help — If you have in-depth questions, the California Department of Insurance offers a variety of resources. If you intend to stay with your current provider, but have questions, calling their help line can usually offer a fast solution.

Mistakes to Avoid

As with any contract, headaches can arise if you don’t understand what you’re agreeing to. Common oversights include:  

• Not Reading the Fine Print —This can lead to unexpected out-of-pocket expenses, network restrictions, or coverage limits. It is crucial to thoroughly review all terms, ensuring that the plan covers the doctors, hospitals, and medications you need.
• Ignoring Plan Adjustments — Health plans can change yearly, with adjustments in premiums, deductibles, and out-of-pocket maximums. Not reviewing these changes can result in paying more than expected or losing the benefits you depend on.
• Not Researching New Options — Each year, new plans might be available that better meet your needs or offer cost savings. Reviewing your options annually ensures you are not missing a better deal or improved coverage. 

The AltaMed Health Insurance Resource Center

Understanding insurance doesn’t have to be overwhelming. With the right resources and guidance, you can make informed decisions that empower your health. If you still have questions or need personalized assistance, the AltaMed Health Insurance Resource Center is here to help. Our experts are ready to explain your options and ensure you get the best coverage for today’s needs. Click here for more information or call (877) 462-2582 to make an appointment.