Health Insurance 101

Health Insurance 101

Did you know?

Plans differ by plan categories, out-of-pocket costs,
and whether they’re private or public.
Financial aid may be available and is based on
your annual household income.
Short-term medical insurance works well for people
in transition, such as those within a year of
becoming Medicare-eligible.

Coverage Options Before Medicare

Not yet eligible for Medicare? You can use Via Benefits to shop for plans from the public marketplace and private insurance carriers. When choosing a health insurance plan, it’s important to understand three core aspects: plan categories, out-of-pocket costs, and Marketplace and Private plans.

Plan Categories

There are four "Metal Tier" categories of insurance plans: Platinum, Gold, Silver, and Bronze. These plans differ based on your out-of-pocket costs rather than the amount or quality of care you receive.

For example, Bronze plans have low premiums, but you'll pay more for medical care. Silver plans are in the middle. Gold plans have higher premiums than Silver plans, but you'll pay less when you visit the doctor.

Doctors

Most health insurance plans work with a specific group or network of doctors and health care providers. If you visit doctors outside the plan’s network, you’ll likely pay more for their services than you would from an in-network doctor.

When researching and choosing coverage, please familiarize yourself with each plan’s provider network and its rules so you know where to go for routine and emergency care.

Out-of-Pocket

Each plan includes different out-of-pocket costs, otherwise known as “cost-sharing.” Cost-sharing amounts can be described in these terms:

Private or Marketplace

Evaluate the Private and Marketplace Plans available in your area and which of your preferred physicians are part of those plan’s networks. Private and Marketplace Plans are required to cover essential health benefits. The difference is that federal subsidies can only be used to reduce the cost of Marketplace plans.

Financial Assistance for Health Insurance

Financial assistance may be available and is based on your estimated annual household income.

Interested in learning more? Visit Financial Aid for Health Insurance or call Via Benefits to see if you qualify for funding.

Consider Getting Short-Term Medical Coverage

Short-term medical insurance may be a good option if you're going to be 65 within a year. These medical plans can be as much as 80% less expensive than standard health care plans. They’re designed to cover you for up to 364 days but could  be renewable for up to three years. They work well for people in transition — such as those within a year of becoming  Medicare-eligible.