Plan Types
Common types include HMOs (usually require in-network care and referrals), PPOs (more flexibility to see out-of-network providers, often at higher cost), EPOs, and high-deductible plans that may pair with an HSA.
Health Insurance
Understand Your Health Coverage Options
Health insurance helps pay for medical care. We'll explain how plans differ so you can compare options with confidence.
Understanding the basics
Key Health Insurance Terms
Premiums
The amount you pay, usually monthly, to keep your plan active — whether or not you use care.
Deductibles
What you pay for covered services before your plan begins to pay. Lower-premium plans often have higher deductibles.
Copayments & Coinsurance
A copay is a fixed amount for a service; coinsurance is a percentage you share after the deductible. Out-of-pocket maximums cap your yearly costs for covered in-network care.
Provider Networks
Networks are the doctors, hospitals, and pharmacies a plan contracts with. Checking that your preferred providers are in-network is essential.
Enrollment Considerations
Many plans can only be purchased during open enrollment or a special enrollment period triggered by qualifying life events, such as losing other coverage, marriage, or a move.
Why people consider it
- Leaving an employer plan
- Self-employment or owning a small business
- A change in family or life circumstances
- Wanting to compare costs and networks
Potential benefits
- Helps manage the cost of medical care
- Access to preventive services
- Protection against high unexpected bills
- Choice among plan designs
Important limitations
- Plans differ in networks and covered services
- Enrollment may be limited to certain periods
- Lower premiums can mean higher out-of-pocket costs
- Not all plans are available in all areas
Eligibility & pricing
What Affects Cost and Eligibility
Costs depend on factors such as plan type, location, age, tobacco use, household size, and in some cases income-based subsidies. Availability varies by county and carrier.
Have Questions? Let's Talk Them Through.
Important Disclosures
- Health insurance plans are offered by licensed carriers. Benefits, networks, costs, and availability vary by plan and location.
- Seven Financial Group does not offer every plan available in your area. Contact HealthCare.gov or your state's marketplace for information on all options.
- [Insurance license disclosure pending verification — add producer name, state license number(s), and affiliated agency here before publishing.]