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    Helpful Tips For Anyone Who Doesn't Understand Health Insurance

    Think of this as Adulting 101: "WTF is Coinsurance?" Edition

    Health insurance is one of those things that probably should have been taught in high school. Because unlike the quadratic formula, it can actually save your ass if something happens to it.

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    But since most of us have no idea how health insurance works, BuzzFeed Health put together this handy guide to get you started. This is by no means an exhaustive list of everything you'll encounter on your quest for coverage, but hopefully it will help you understand US health insurance options a little better.

    Here's a quick rundown of what we'll cover:


    * Where to actually get health insurance

    * What all those health insurance words mean

    * How to know which plan is right for you

    * Where to go if you still have questions

    To get this info, BuzzFeed Health spoke with experts who really know this stuff: a representative at the US Department of Health and Human Services, and health insurance industry expert Sally Poblete, CEO of Wellthie.

    Listen, we don't know your life. And where you get your health insurance depends on your current situation. So, here are some of the most common ways you might get insurance:

    # Employer-sponsored health insurance

    # Individual insurance through the Health Insurance Marketplace

    # Individual insurance through a private insurance company or broker

    # Student health insurance

    # Medicaid

    (Medicare is also an option for people over 65 or certain younger people with disabilities.)

    So, here's a little more info on each of those options:

    1. Employer-sponsored health insurance


    This is health insurance you get through your job* (or through your parents' or spouse's job), also known as a group health plan. If you get health insurance through your job, you're only able to choose or change a plan during your company's open enrollment period (ask your boss or HR department when that is). The only exception is if you have a qualifying life event, like changing jobs, having a baby, getting married, or moving.

    If you're under 26, you can stay on your parents' plan. But once you turn 26, that counts as a qualifying life event, and you'll have 60 days (before or after your birthday) to find new coverage.

    *You might not get health insurance through your job if you're a part-time employee or if you work for a small business that employs fewer than 50 people, says Poblete.

    2. Individual insurance through the Health Insurance Marketplace


    Also known as the health insurance exchange, this is a place where you can shop for individual insurance. This means that you're getting the insurance for yourself (and maybe your family or spouse), rather than getting it through your employer.

    You can access the Marketplace at You can only choose or change a plan during the open enrollment period, which is going on right now. Although December 15 is the last day to enroll for coverage that starts on January 1, open enrollment extends until January 31. The only time you can buy health insurance outside of open enrollment is if you have a qualifying life event, like changing jobs, having a baby, getting married, or turning 26.

    So how does the Marketplace work? You can file your application over the phone, online, or in-person. Based on your income, you might be eligible for something called an advanced premium tax credit (APTC), which is basically money that the government pays to help cover the cost of your monthly health insurance premiums.

    According to an HHS spokesperson, most people who use the Marketplace are eligible for these tax credits — as long as your annual income is between 100% and 400% of the federal poverty line. Currently, that's between $11,880 and $47,520 for a single person, and between $24,300 and $97,200 for a family of four (find more info on that here.) If you make above 400% of the federal poverty line, you will not get a tax credit. If you make below 100% of the federal poverty line, you may be eligible for Medicaid.

    3. Individual insurance through a private insurance company or broker


    This is for people who don't get insurance through their jobs (or their parents' or spouse's jobs) and choose not to get insurance through the Marketplace. If that's the case, you can either go straight to an insurance company or go to a health insurance broker, who can help answer your questions and go over different options in your area.

    You can do this by Googling around for private health insurance companies or health insurance brokers in your state. According to Poblete, the price of a plan should be the same whether you get it through the Marketplace or through an insurance company or broker.

    Are you a freelancer? You can also check out individual insurance plans through Freelancers Union.

    4. Student health insurance

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    If you're a college student who isn't covered under your parents' plan or an employer plan, you may be able to get student health insurance through your school. Contact your school's health services department to find out more.

    5. Medicaid


    As we mentioned before, if you make less than 100% of the federal poverty line, you may be eligible for Medicaid, which provides free or low-cost health insurance coverage.

    Medicaid eligibility varies from state to state, but you can check here if it's right for you.

    OK so you know where to get insurance, but you still don't totally know what it is. That's fair. Here are some terms you should get to know:

    * Premium: This is the monthly cost of your health insurance plan. It might come out of your paycheck if you get insurance through your job.

    * Copay: This is the flat rate you're charged for doctors visits and prescriptions. It can vary for different services (for instance, a $20 copay to see your primary care doctor, $50 copay for a specialist, and a range of copays for prescriptions).

    * Deductible: This is the amount you have to pay for health services before your insurance plan starts to pay. So if you have a $1,000 deductible, that first $1,000 is on you. This doesn't apply to your monthly premiums or free preventive services, and it may not apply to copays. But let's say you need to have some tests or X-rays done — that would count towards your deductible.

    * Coinsurance: This is the percentage of costs you have to pay after you've met your deductible. So let's say you need a medical procedure that costs $2,000. If you already met your deductible, you would only have to pay the coinsurance for that. So if your coinsurance is 20%, you'd only have to pay $400 for that $2,000 procedure.

    * Out-of-pocket maximum: This is the most you would have to pay for health insurance in a given year, not including monthly premiums or any services your plan doesn't cover. So once you hit your deductible and you start paying just the coinsurance on everything else, your insurance covers everything once you hit that out-of-pocket maximum.

    * PPO: This is a Preferred Provider Organization, or a type of health insurance plan that has a broad list of participating providers and hospitals, so you're charged less if you see those in-network doctors. You can also use out-of-network doctors at a higher cost.

    * HMO: This is a Health Maintenance Organization, or a type of a health insurance plan that limits coverage to in-network doctors and hospitals that work with them. They typically won't cover out-of-network care unless it's an emergency.

    * Health Savings Account (HSA): This is a savings account specifically for medical expenses, so you can set aside pre-tax money to pay for upcoming healthcare costs if you're in a high-deductible plan.

    Again, this isn't an exhaustive list, but you can find more healthcare terms here.

    Regardless of where you get your health insurance, you'll have the option to select a specific plan. In the Marketplace, these plans are classified as Bronze, Silver, Gold, and Platinum (based on how you and your insurance split the cost). Outside of the Marketplace, you'll just get a range of plans to choose from that differ from each other in a similar fashion.

    When choosing a plan, here are a few things to consider:

    First, think about how often you go to the doctor, get prescriptions, or do something that lands you in the ER.


    If you have a medical condition or chronic illness, you probably visit doctors or specialists pretty regularly, and maybe you have several prescriptions to fill throughout the year. In that case, you'll probably want to look at plans that have a lower deductible, since you know you'll have a lot of healthcare costs in the upcoming year, and once you hit the deductible the rest of your costs will be mostly covered. That said, a lower deductible generally means a higher monthly premium. So you might pay more each month, but you'll pay less when it comes to the services you use on a regular basis.

    But if you're someone who went to the doctor twice last year and very rarely gets prescriptions, you might want to opt for a lower monthly premium and higher deductible. That means you'll be paying less each month, but you might face a higher cost if you do end up at the doctor.

    Next, consider how much you can afford to spend on health insurance each month, and how risk-averse you are.


    Choosing a health insurance plan is often about how much you want to pay for peace of mind. If you're really not sure what your healthcare costs will look like next year, think about if you'd rather (a) spend more money each month just in case you end up needing a lot of medical care next year, or (b) spend a little each month, and hope that you don't need a lot of medical care next year. (Of course, there's usually an option somewhere in the middle, too.)

    Maybe you can afford a higher monthly cost and you'd appreciate the predictability that comes with knowing you'll have a lower copay and lower deductible if you get really sick.

    Or maybe you can really only afford the lowest monthly cost, so you're cool with risking the higher copay and higher deductible should something major happen to come up.

    Then think about what doctors you typically see, and if they'll be covered under this insurance plan.


    Do you have a doctor you love and can't live without? Make sure they'll be covered under the specific insurance plan and network you select.

    Do you want the flexibility to see lots of different providers? A PPO plan might be best, so you'll have a big list of in-network doctors, plus out-of-network providers you can see at a higher cost. Or do you rarely see the doctor and not have any favorites already? If an HMO plan is offered, that might be right for you.

    There is no "best" plan. It's all about what works for your needs.

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    Choosing the "platinum" plan or the plan that gives you access to every doctor imaginable isn't actually best if it means you're overpaying for health insurance.

    Everyone wants to know what's a "good plan," but unfortunately there's no clear-cut answer. "It's about what your needs are and finding the right plan to cover your needs for your budget," says Poblete.

    Keep in mind that there's a hefty fee for not having health insurance.

    This is sometimes called the "penalty" or the "individual mandate." The fee is either 2.5% of your annual household income or $695 per adult (and $347.50 per child) — whichever is higher. This fee is paid when you file your taxes for the year.

    There are some exceptions to this, but you can find out more about all that here.

    BUT WAIT — isn't the Affordable Care Act being repealed/replaced/amended per President-elect Donald Trump?

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    Maybe. But we probably won't know what the new plan is for a while, and open enrollment is happening right now. So if you wait to see what happens, you might be without coverage for the whole year.

    "At this point I would say focus on getting insurance for right now, for this plan year starting January 1," says Poblete. "Any changes that could happen would likely take a while. And at this moment in time you have the opportunity to buy insurance, and you still have the opportunity to get a lot of financial assistance from the government when doing so."

    In fact, more than 100,000 people signed up for health insurance through the Marketplace the day after the election, according to an HHS representative, beating the record for any single day up until that point.

    Still have questions? Of course you do — this is complicated stuff. Here are some places to go for help:

    * Still don't really understand all those healthcare terms? You can find a glossary here.

    * Want to learn more about the Marketplace? Visit

    * Need a local navigator to help you understand your options in the Marketplace? You can find that here.

    * Want health insurance advice specifically for millennials? Visit

    * Have general questions about health insurance options? Visit or

    * And don't forget to contact your HR department if you get insurance through your job, or visit your campus health services if you're interested in student insurance.