Health Insurance

If you require health care services, health insurance can make medical treatment far more affordable. Health insurance is a form of insurance coverage that can help you pay for medical, surgical, and prescription drug costs. In most cases, a health insurance policy will either reimburse policyholders for covered expenses or they will directly pay the health care provider for services rendered to the insured. 

In some cases, you may be able to find health insurance through your employer, but if you don’t have employer-based coverage, you will need to look elsewhere. Be sure to verify that you are not eligible for employer-based coverage before shopping for private insurance plans, because an employer sourced insurance policy may be far more affordable than the alternatives. If you are not eligible for an employer plan, you should read up on health insurance so you can more easily.

Who Needs Health Insurance

You may be asking yourself whether you need to invest in health insurance. Well, in most cases, the answer is yes. Without health insurance, you may be subject to paying massive amounts of money for any health care procedures that you need. With even the most basic medical treatments costing thousands of dollars, you don’t want to need care and not be able to afford it. This is especially true for senior citizens who are more prone to illness and injury.

What Does Health Insurance Cover

Health insurance generally covers health care services that are delivered through medical facilities, such as hospitals, doctors’ offices, and outpatient care facilities. While your health insurance may cover some dental care, you may need to buy a separate dental insurance policy to gain access to extensive dental care. The same rule applies to vision care. Health insurance will cover eye-related surgeries or other procedures, but to get coverage for basic eye exams and eyewear, you will need to purchase a separate vision insurance policy.

Types of Health Insurance

There are several different types of health insurance for consumers to choose from. After the Affordable Care Act was passed, a health insurance marketplace was created. Using this marketplace, you can shop for plans in your area. Plans sold in the marketplace are often referred to as on-exchange private health insurance. Plans that are sold directly or through a third-party broker are called off-exchange private health insurance.

Employer coverage, Medicare, Medicaid, and short-term health insurance plans are other options for people who need health coverage. Here’s what you need to know about each type of health insurance.

On-exchange Health Insurance

Health insurance policies that are sold on government-run exchanges must offer ten essential benefits. The ten required insurance categories include:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Pregnancy/maternal care
  • Mental health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive care and wellness services
  • Pediatric services, including oral and vision care

Furthermore, any insurance company that wants to offer plans on-exchange must offer plans that fit into each metal tier. This means you will have options at every price point from your insurer of choice. Another benefit of on-exchange insurance is that you may qualify for premium tax credits and cost-sharing reductions that significantly lower the cost of coverage. 

Off-exchange Health Insurance

Health insurance that is sold directly through insurance companies or privately-run insurance marketplaces falls into this category. Off-exchange plans still must offer the ten essential benefits, but you cannot use premium tax credits or other subsidies with these plans. The insurers also don’t have to offer a plan at every metal tier, so they have more flexibility in what insurance products they sell. This can result in lower prices for the end consumer.

Employer-based Health Insurance

Employer-based coverage, or group plans, are private plans that are managed by an employer. These plans also must cover the ten essential benefits and follow many of the other rules applied to other private insurance policies. The difference with employer-based coverage is that the plan covers a large number of people. Therefore, coverage costs for each individual may be significantly lower.

Short-term Health Insurance

If you are experiencing a temporary gap in coverage, you can purchase a short-term health insurance policy. Though short-term policies are not qualifying health coverage, therefore they may not provide you with all of the benefits you need. Short-term plans may also have limitations that other insurance policies do not. Still, if your coverage has ended and you are waiting on a long-term policy to go into effect, short-term coverage is the best solution for you.


Medicare is a government-backed insurance program that is available to senior citizens and people who have been diagnosed with qualifying disabilities. To qualify for Medicare, you generally must be age 65 or older. Though, it is possible to qualify based on disabilities. If you have collected Social Security benefits for at least 24 months, you can qualify for Medicare. There are certain conditions that may allow you to qualify sooner as well. Once you enroll in Medicare, you can sign up for hospital insurance, medical insurance, and prescription drug coverage through the program. In some cases, the government will subsidize premiums for the hospital insurance portion, ask an insurance agent if you qualify for this benefit.


Low-income families can get health care insurance through Medicaid. To determine if you are eligible for Medicaid benefits, you can check with healthcare.gov or your state’s local exchange.

How Does Health Insurance Work

Your health insurance may be structured differently depending on which plan you choose. There are four primary formats for private health insurance policies, each offering different benefits.

Health Maintenance Organization

A Health Maintenance Organization (HMO) plan is a more restrictive type of health insurance plan that only allows you to see in-network health care providers. You’ll also need a referral to see specialists. If you do choose an HMO, keep in mind that these plans do not cover costs associated with any out-of-network visits.

Preferred Provider Organization

Preferred Provider Organization (PPO) plans are far less restrictive than HMO plans, as they allow policyholders to access out-of-network health care providers as they please. Though, in-network doctors can be seen at lower costs in most cases. With a PPO plan, you won’t need a referral to see a specialist either.

Exclusive Provider Organization

Exclusive Provider Organization (EPO) plans combine the rules of HMO and PPO plans. While you can see a specialist without a referral in EPO plans, you can’t have your out-of-network medical care covered by the policy. This makes EPO plans less expensive than PPOs, but more expensive than HMOs.

Point of Service

Point of Service (POS) plans are another mix of HMO and PPO plans. With these plans, you have a primary care provider within a network. The primary care provider coordinates your care, but you’ll also have access to out-of-network providers at a higher cost than in-network providers. In addition to that, you will also need a referral to see HMO specialists.

Discover Health Insurance Costs

The cost of health insurance varies based on your age, location, and the type of plan you choose. To develop a concrete idea of how much health insurance will cost you, get help from an insurance specialist. The talented agents at Legacy Peace Of Mind, Inc understand the insurance market and they can help you compare policies.

If you have any additional questions related to Medicare, our team of Colorado Medicare experts is happy to help you. Contact us at 970-233-0063 today.