Health Coverage Basics.
Health coverage can be confusing. It is a good idea to start with a few basic concepts and a glossary of terms. When you are finished here, use the menu at the top of the screen to navigate the rest of the site.
What is 'Health Coverage'?
When we talk about health coverage we mean the ability to pay for health services with the help of either private health insurance or public health coverage.
Private Health Insurance
A private health insurance policy is a financial contract between a policyholder and an insurance company. The insurer agrees to pay for a defined set of health services up to a defined amount of money in the event that you use those services. This protection remains in force for a specified "policy term," typically a year, after which you will need to renew the policy in order to continue the coverage. In return for coverage, you pay the insurer a specified amount, called the "premium." Premiums are typically paid in monthly installments, but may also be paid all at once or in other intervals.
There are two basic kinds of private health insurance policies: Group health insurance and individual health insurance. In group health insurance, a single policy covers a defined group of people, like the employees of a firm. Most people with group insurance get it through their employer. In individual insurance,the policy covers you and any family members you would like to cover. People buy individual insurance directly from an insurance company or through an insurance agent or broker. You can learn more about group and individual coverage under Individuals & Families.
Public Health Coverage
Public health coverage is coverage provided by a public program such as Medicare, Medicaid, or FAMIS. Although people commonly refer to these three programs as 'health insurance', they are not technically insurance. Enrolled individuals do not purchase an 'insurance policy' or enter into a financial contract with the program. The program simply agrees to pay all or part of the cost of a defined set of health services on behalf of the enrolled person. You can learn more about these programs under Individuals & Families.
Care without Coverage
People who do not have private insurance or public health coverage can still seek health care from a provider who is willing to serve uninsured individuals. Many of these providers deliver care at low cost or no cost depending on the income level of the patient. You can learn more about these providers under Care without Coverage.
