The Value of

Health Insurance

5 things to know about health insurance

1.	 Different health insurance policies can offer different

benefits, and some can limit which doctors, hospitals, or

other providers you can use.

2.	 You may have to pay a deductible each plan year before

your insurance company starts to pay for care you get.

For example, let’s say you have a $200 deductible. You

go to the emergency room and the total cost is $1,250.

You pay the first $200 to cover the deductible, and then

your insurance starts to pay its share.

3.	You may have to pay coinsurance or a copayment as your

share of the cost when you get a medical service, like a

doctor visit, hospital outpatient visit, or a prescription.

Coinsurance is usually a percentage amount (for example,

20% of the total cost). A copayment is usually a fixed

amount (for example, you might pay $10 or $20 for a

prescription or doctor visit).

4.	Health insurance plans contract with networks of hospitals,

doctors, pharmacies, and health care providers to take

care of people in the plan. Depending on the type of

policy you buy, your plan might only pay for your care

when you get it from a provider in the plan’s network, or

you may have to pay a bigger share of the bill.

5.	You might see products that look and sound like health

insurance, but don’t give you the same protection as

full health insurance. Some policies only cover certain

diseases or if you’ve been hurt in an accident. Some only

offer you discounts on health services. Don’t mistake

insurance-like products for full comprehensive insurance

protection.

Get more information about how insurance works at

HealthCare.gov. You can also call the Health Insurance

Marketplace Call Center at 1-800-318-2596. TTY users

should call 1-855-889-4325.

CMS Product No. 11631

Revised June 2015
Health coverage helps pay costs when

you need care

No one plans to get sick or hurt, but most people need

medical care at some point. Health coverage helps pay

for these costs and protects you from very high expenses. 

What is health insurance?

Health insurance is a contract between you and an

insurance company. You buy a plan, and the company

agrees to pay part of your medical costs when you get

sick or hurt.

There are other important benefits of health insurance.

Plans available in the Health Insurance Marketplace

(and most other plans) provide free preventive care, like

vaccines and check-ups. They also cover some costs for

prescription drugs.

Health insurance helps you pay for care

Did you know the average cost of a 3-day hospital stay

is $30,000? Or that fixing a broken leg can cost up to

$7,500? Having health coverage can help protect you

from high, unexpected costs like these.

Your insurance policy or summary of benefits and

coverage will show what types of care, treatments,

and services your plan covers, including how much the

insurance company will pay for different treatments in

different situations.

What you pay for health insurance

You’ll usually pay a premium every month for health

coverage, and you may also have to meet a deductible

each year before the insurance company starts to

pay its share. A deductible is the amount you owe for

health care services your health insurance or plan covers

before your health insurance or plan begins to pay. For

example, if your deductible is $1,000, your plan won’t

pay anything until you’ve met your $1,000 deductible for

covered health care services subject to the deductible.

The deductible may not apply to all services.

How much you pay for your premium and deductible is

based on the type of coverage you have.

Just as important as the premium cost and deductible is

how much you have to pay when you get services.

Examples include:

• What you pay out-of-pocket for services after you

pay the deductible (coinsurance or copayments)

• How much in total you’ll have to pay if you get sick

(the out-of-pocket maximum)

The policy with the cheapest premium may not cover

many services and treatments.