What is medical insurance?

Medical insurance helps cover the cost of healthcare services such as doctor visits, hospital stays, prescription drugs, and preventive care. It protects you financially from high or unexpected medical expenses.

Why do I need medical insurance?

Medical care can be expensive. Insurance provides access to affordable care and helps protect your savings from large medical bills due to illness, injury, or hospitalization.

What types of medical insurance plans are available?

• HMO (Health Maintenance Organization): Requires choosing a primary care physician (PCP) and referrals for specialists.
• PPO (Preferred Provider Organization): Offers more flexibility in choosing providers and doesn't require referrals.
• EPO (Exclusive Provider Organization): Similar to PPO but doesn’t cover out-of-network care.
• High-Deductible Health Plans (HDHPs): Paired with HSAs, these have lower premiums and higher deductibles.

What’s the difference between premium, deductible, and co-pay?

• Premium: Monthly fee to maintain your insurance plan.
• Deductible: Amount you pay out-of-pocket before insurance starts covering services.
• Co-pay: Fixed amount you pay for specific services (like $25 for a doctor visit).
• Co-insurance: Percentage of costs you share with the insurer after meeting the deductible.

What does medical insurance typically cover?

Most plans cover:

• Doctor visits and specialist care
• Emergency room services
• Hospitalization and surgery
• Prescription drugs
• Preventive services (checkups, vaccines)
• Mental health and substance use treatment
• Maternity and newborn care

What is an in-network vs. out-of-network provider?

• In-network: Providers who have agreed to discounted rates with your insurance.
• Out-of-network: Providers who don’t have a contract with your insurer, which means higher out-of-pocket costs.

How do I find out if a doctor is in-network?

You can check the insurance company’s website, call customer service, or ask the provider’s office directly.

What is an Explanation of Benefits (EOB)?

An EOB is a statement from your insurance company detailing what services were billed, what they covered, and what you may owe.

Can I use my insurance for out-of-country medical care?

Some plans offer limited coverage for international care. Check with your insurer before traveling and consider travel health insurance for additional protection.