Back to Health plan 101

Understanding how health coverage works

Health plan coverage protects you against unexpected and potentially high costs of medical care.

With a health plan, your plan carrier pays for specific covered services for you with in-network providers. A health plan is a contract between you and your plan carrier. Below you can learn more about the various parts of this contract, how to choose a plan and what happens once you enroll.

How do I get health coverage?

There are four main ways to get health coverage that depend on various aspects of your life, such as age and employment:

  • Employer or group coverage: This is health coverage that is paid for by you and your employer. Eligibility may vary depending on your employer, with qualifiers such as how many hours you work each week. These plans generally include an employee’s spouse and dependents under age 26.
  • Individual & family coverage: These health plans are available to anyone age 18 and older who does not receive coverage through their employer but makes too much annually to be eligible for government assistance through Medicaid. View our Individual & Family coverage education page.
  • Medicare coverage: This is federal health coverage available to individuals age 65 and older and some younger people who receive Social Security disability benefits. While this coverage helps with the cost of health care, it does not cover all medical expenses or the cost of long-term care.
  • Medicaid coverage: This is federal and state-run health coverage available to people with limited income who do not have coverage through their employer or qualify for Medicare coverage. Learn more about Medicaid coverage at medicaid.gov

Understanding enrollment periods

Depending on the coverage you are eligible for, there are specific periods in which you can enroll:

  • View our Individual & Family plan enrollment
  • Employer coverage enrollment varies by employer. You typically have an initial enrollment period when you start a new job, and each year there is an open enrollment period where you can change the health coverage you currently have. Speak with your plan administrator to determine when that annual enrollment period occurs.

You’ve enrolled in our plan, so what’s next?

Having health coverage through us is more than just saving money on the cost of health care. We offer members additional benefits based on their plan that help them take control of their health: