How to Get Health Insurance

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Types of health insurance plans
Comparing health insurance plans: HMO vs. PPO vs. EPO vs. POS
Plan type | Do you have to stay in-network to get coverage? | Do procedures & specialists require a referral? | Snapshot: |
---|---|---|---|
HMO: health maintenance organization | Yes, except for emergencies. | Yes, typically. | Lower out-of-pocket costs and a primary doctor who coordinates your care for you, but less freedom to choose providers. |
PPO: preferred provider organization | No, but in-network care is less expensive. | No. | More provider options and no required referrals, but higher out-of-pocket costs. |
EPO: exclusive provider organization | Yes, except for emergencies. | No, typically. | Lower out-of-pocket costs and usually no required referrals, but less freedom to choose providers. |
POS: point of service plan | No, but in-network care is less expensive. | Yes. | More provider options and a primary doctor who coordinates your care for you, with referrals required. |
Plan type | Snapshot |
---|---|
HMO: health maintenance organization | Lower out-of-pocket costs and a primary doctor who coordinates your care for you, with referrals required to see a specialist. You must stay in-network except for emergencies. |
PPO: preferred provider organization | More provider options and no required referrals, but higher out-of-pocket costs. You can go out of network, but care will be more expensive. |
EPO: exclusive provider organization | Lower out-of-pocket costs and usually no required referrals, but less freedom to choose providers. You must stay in-network except for emergencies. |
POS: point of service plan | More provider options and a primary doctor who coordinates your care for you, with referrals required to see a specialist. You can go out-of-network, but care will be more expensive. |
High-deductible health plans
Where to buy health insurance
Health insurance through work
Health insurance through the marketplace
Off-marketplace health insurance
When can you sign up for health insurance?
- You started a new job that offers health benefits. You must sign up during the benefits window specified by your employer — it typically lasts 14 to 30 days.
- Annual open enrollment from Nov. 1 to Jan. 15. (This can vary slightly by state, so check open enrollment dates in your location.)
- You have a qualifying life event. If you experience a life change, such as getting married or having a baby, you may qualify for a special enrollment period
.
How to compare health insurance plans
- Evaluate your budget. Sign up for the plan with a monthly premium you can manage, as well as out-of-pocket costs that make sense for you. You should also consider whether you might want a high-deductible health plan.
- Ponder how much network flexibility you want. Do you want to be able to go out-of-network to see specialists? If so, you’ll want a plan with out-of-network coverage options.
- Check your preferred doctors. What insurance plans do your preferred providers and facilities accept? Make sure you choose a plan that includes them in their network.
- Evaluate the scope of services. Look through each plan’s summary of benefits to understand the overall coverage situation, particularly if you have specific needs, such as coverage for fertility treatments or physical therapy.
- Keep prescriptions in mind. If you take regular prescription medication, see how each plan covers it and how much it will cost you.
What to do if you lose coverage
- Enroll in COBRA coverage. The Consolidated Omnibus Budget Reconciliation Act (COBRA) allows you to keep the health insurance you were getting through work, even after you’ve lost your job
. You can keep COBRA for 18 to 36 months, but you’ll be paying the full premium out-of-pocket without employer help, so it can be pricey. - Sign up for a marketplace plan. Losing health benefits counts as a qualifying life event, so you can buy health insurance through the federal or state marketplace even if it’s not an open enrollment period.
- Buy off-marketplace health coverage. You may be able to buy plans directly from an insurance company or broker, but you won’t be eligible for premium tax credits or other savings.
Article sources
- 1. U.S. Census Bureau. Health Insurance Coverage in the United States: 2023. Accessed Feb 4, 2025.
- 2. Department of Health & Human Services. High Deductible Health Plan (HDHP). Accessed Feb 4, 2025.
- 3. Department of Health & Human Services. Health plan categories: Bronze, Silver, Gold & Platinum. Accessed Feb 4, 2025.
- 4. Department of Health & Human Services. Qualifying life event (QLE). Accessed Feb 4, 2025.
- 5. Department of Health & Human Services. Changing plans after you've enrolled. Accessed Feb 4, 2025.
- 6. U.S. Department of Labor. COBRA Continuation Coverage. Accessed Feb 4, 2025.