Welcome to Health Insurance 101!
Health insurance comes with a lot of jargon and a lot to learn, but you don’t have to figure it out alone. We’re here to help you understand how health insurance works so that you're prepared to use it at Curry Health Center's Medical Clinic.
Health insurance helps cover medical costs, like doctor visits, medications, and emergencies, so you’re not paying full price when you need care.
Want to learn more health insurance basics?
Health Insurance 101
Different Types of Health Insurance
There are 3 main plan types. Knowing the basics helps you understand your coverage (or pick a plan).
How do I know what plan I have?
- Check your insurance card, some will list HMO, PPO, etc. (See sample card below)
- Review your plan documents (look for “Explanation of Benefits”)
- Log into your insurance account online
- Call your insurance provider and ask
Not a real insurance card. For educational purposes only.
Plan Types Explained
HMO (Health Maintenance Organization)
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You must see doctors in your network.
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Usually need a referral from your primary doctor to see a specialist.
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Often requires choosing a primary care doctor.
PPO (Preferred Provider Organization)
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You can see doctors in or out of your network (out-of-pocket costs may be higher if you go out-of-network).
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Usually don’t need referrals for specialists.
HDHP (High-Deductible Health Plan)
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Works like a PPO.
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Lower monthly payments, but higher deductibles.
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Often comes with a Health Savings Account (HSA) to help pay medical costs.
The Big 4: Costs You’ll Hear About
Not a real insurance card. For educational purposes only.
Co-pay: A small fixed cost when you get care. (Example as seen above: $15 for an office visit)
Deductible: What you pay before insurance starts sharing costs. (Example as seen above: You must pay $50 this year before your insurance will pay for care.
Premium: What you pay monthly to have insurance, even if you don’t use it. (Will be listed on your initial policy documents, online portal through your insurance carrier's website, or payroll deductions)
Co-insurance: The percentage you pay after meeting your deductible. (Example: $500 bill → 20% you pay ($100), 80% insurance pays ($400)).
Guides and Tips
Insurance Glossary
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A bill your doctor sends to your insurance for services you've received.
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The most you'll pay in a year for medical services covered by your insurance. After you reach this limit, insurance pays for 100% of services you receive.
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Doctors or providers who have a contract with your insurance company. You usually pay less here.
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Doctors who don't have a contract with your insurance company. You usually pay more for services here.
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Your primary doctor's permission to see a specialist or receive certain services.
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The services, treatments, or prescriptions your health insurance plan will pay for.
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The set period of time each year to sign up, renew, or update your insurance coverage.
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A major life change (like moving or getting married) that lets you enroll in an insurance plan outside of the open enrollment time period.