Health insurance helps protect you from high medical care costs. It is a contract between you and your insurance company. You buy a plan or policy, and the company agrees to pay part of your expenses when you need medical care.

Many people in the United States get a health insurance policy through their employers. In most cases, the employer helps pay for that insurance. Insurance through employers is often with a managed care plan. These plans contract with health care providers and medical facilities to provide care for members at reduced costs. You can also purchase health insurance on your own.

People who meet certain requirements can qualify for government health insurance, such as Medicare and Medicaid. The Affordable Care Act expands health insurance coverage for many people in the U.S.

Health care can be costly. If you have health insurance, it usually pays at least part of your medical costs. If you don't have insurance or need help with costs that aren't covered, financial assistance might be available. Certain government programs and nonprofit organizations can help. You can also discuss concerns about paying your medical bills with your health care provider, social worker or the business office of your clinic or hospital.

Managed care plans are a type of health insurance. They have contracts with health care providers and medical facilities to provide care for members at reduced costs. These providers make up the plan's network. How much of your care the plan will pay for depends on the network's rules.

Plans that restrict your choices usually cost you less. If you want a flexible plan, it will probably cost more. There are three types of managed care plans:

• Health Maintenance Organizations (HMO) usually only pay for care within the network. You choose a primary care doctor who coordinates most of your care.
• Preferred Provider Organizations (PPO) usually pay more if you get care within the network. They still pay part of the cost if you go outside the network.
• Point of Service (POS) plans let you choose between an HMO or a PPO each time you need care.

Medicaid is government health insurance that helps many low-income people in the United States to pay their medical bills. The Federal government sets up general guidelines for the program, but each state has its own rules. Your state might require you to pay a part of the cost for some medical services.

You have to meet certain requirements to get Medicaid help. These might involve

• Your age
• Whether you are pregnant, disabled, or blind
• Your income and resources
• Whether or not you are a U.S. citizen or, if not, what your immigration status is

Authorized by Title XIX of the Social Security Act, Medicaid was signed into law in 1965 alongside Medicare. All states, the District of Columbia, and the U.S. territories have Medicaid programs designed to provide health coverage for low-income people. Although the Federal government establishes certain parameters for all states to follow, each state administers their Medicaid program differently, resulting in variations in Medicaid coverage across the country.

86.7 Million People Covered*

*March 2023 Enrollment Report

Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered by states, according to federal requirements. The program is funded jointly by states and the federal government.

Medicare is the U.S. government's health insurance program for people age 65 or older. Some people under age 65 can qualify for Medicare, too. They include those with disabilities, permanent kidney failure, or amyotrophic lateral sclerosis.

Medicare helps with the cost of health care. It does not cover all medical expenses or the cost of most long-term care. The program has four parts:

• Part A is hospital insurance
• Part B helps pay for medical services that Part A doesn't cover
• Part C is called Medicare Advantage. If you have Parts A and B, you can choose this option to receive all of your health care through a provider organization, like an HMO.
• Part D is prescription drug coverage. It helps pay for some medicines.

When choosing a plan, it’s a good idea to think about your total health care costs, not just the bill (the “premium”) you pay to your insurance company every month.

Other amounts, sometimes called “out-of-pocket” costs, have a big impact on your total spending on health care – sometimes more than the premium itself.

Beyond your monthly premium: Deductible and out-of-pocket costs

• Deductible: How much you have to spend for covered health services before your insurance company pays anything (except free preventive services)
• Copayments and coinsurance: Payments you make each time you get a medical service after reaching your deductible
• Out-of-pocket maximum: The most you have to spend for covered services in a year. After you reach this amount, the insurance company pays 100% for covered services.

How to estimate your yearly total costs of care

In order to pick a plan based on your total costs of care, you’ll need to estimate the medical services you’ll use for the year ahead. Of course it’s impossible to predict the exact amount. So think about how much care you usually use, or are likely to use.

• Before you compare plans when you’re logged in to HealthCare.gov or preview plans and prices before you log in, you can choose each family member’s expected medical use as low, medium, or high.
• When you view plans, you’ll see an estimate of your total costs — including monthly premiums and all out-of-pocket costs — based on your household’s expected use of care.
• Your actual expenses will vary, but the estimate is useful for comparing plans’ total impact on your household budget.

Total costs & “metal” categories

When you compare plans in the Marketplace, the plans appear in 4 “metal” categories: Bronze, Silver, Gold, and Platinum. The categories are based on how you and the health plan share the total costs of your care.

Generally speaking, categories with higher premiums (Gold, Platinum) pay more of your total costs of health care. Categories with lower premiums (Bronze, Silver) pay less of your total costs. (But see the exception about Silver plans below.)

So how do you find a category that works for you?

• If you don’t expect to use regular medical services and don’t take regular prescriptions: You may want a Bronze plan. These plans can have very low monthly premiums, but have high deductibles and pay less of your costs when you need care.
• If you qualify for "cost-sharing reductions": Silver plans may offer good value. If you qualify for extra savings ("cost-sharing reductions") your deductible will be lower and you’ll pay less each time you get care. But you get these cost-sharing reductions ONLY if you enroll in Silver plan. If you don’t qualify for extra savings, compare premiums and out-of-pocket costs of Silver and Gold prices to find the right plan for you.
• If you expect a lot of doctor visits or need regular prescriptions: You may want a Gold plan or Platinum plan. These plans generally have higher monthly premiums but pay more of your costs when you need care.