Health Insurance 101

Health insurance 101

Health insurance doesn’t have to be tricky. Understanding the basics makes it simpler to navigate and helps you make confident choices about your coverage.

What is health insurance?

Health insurance helps cover the costs of doctor visits, hospitals and medical emergencies. It provides financial protection in case of illness or accidents and can include extras like vision or dental care. Coverage varies by plan, but overall, it helps pay for your medical expenses when you need it most.

Why get health insurance?

Even if you’re young and healthy, it’s still important for staying well and preventing health issues. There are plenty of plan options that can be tailored to fit your needs.

Health insurance is your safety net against unexpected medical costs—accidents and illnesses can happen out of the blue, and without coverage, those expenses can quickly add up.

Top ways to get coverage

Employer

The majority of people purchase insurance through their employer.

Government

If you’re eligible, you can also get insurance through government programs like Medicare, Medicaid, CHIP or the Veterans Health Administration.

Marketplace 

You can also purchase insurance directly from the federal marketplace or state marketplaces that offer Affordable Care Act (ACA) plans.

What are health insurance plan types?

Health Maintenance Organization (HMO)


This type of insurance limits members to its own network of doctors, hospitals and providers. While members can usually choose their own Primary Care Physician (PCP), an HMO typically won’t cover out-of-network care unless authorized beforehand or in an emergency.

Exclusive Provider Organization (EPO)


An EPO (Exclusive Provider Organization) is similar to an HMO as it is a healthcare plan type that covers eligible services from providers and facilities inside a network. Generally, an EPO does not pay for services from out-of-network providers and facilities except for emergency services, similar to an HMO. Unlike an HMO, EPO participants are not usually required to have a primary care physician or referrals.

Preferred Provider Organization (PPO)


A PPO (Preferred Provider Organization) is a healthcare plan that allows people to see doctors or get services that are not part of a network. Those out-of-network services are at a higher rate, though. Plans are structured so that members will pay less out-of-pocket when using in-network providers.

You’re 26 and ready to pick your first insurance plan—what now?

When you reach 26, you can no longer stay on your parent’s health insurance plan, but don’t worry! This is considered a life event, so you can use the special enrollment period to choose a plan that works for you and keep your coverage gap-free. 

60 days

You have 60 days before and after
your birthday to enroll in a new plan.

Mind the gap

Enroll so you don’t have a coverage gap.

Get started

Start with your employer or the
ACA Marketplace.

What you need to enroll

Qualifying life events may include:

  • Getting married or divorced
  • Having or adopting a child
  • Losing a loved one on your health plan
  • Moving to a new area
  • Turning 26
  • Changes in employment
  • Losing health insurance

What about other qualifying life events?

Big life changes—expected or otherwise—can affect your health insurance. If you experience a qualifying life event, you may be able to update your health plan outside of open enrollment.

Not sure if your situation qualifies? Check your plan materials, ask your employer or call the number on your member ID card for guidance.

Qualifying life events

Want to know more?

Health insurance costs

We’ll break down what you pay and why, plus reveal some tips to help you save.

How costs work

Shopping for health insurance

Everything you need to navigate your coverage options with confidence and clarity.

Shop smarter

Terms to know

Decode insurance jargon with simple, straightforward explanations.

Learn the lingo

Read More on The Blueprint

Let’s find the right plan for you

With Blue KC, you get a name generations have trusted, coverage you can count on and peace of mind knowing your plan is here with you every step of the way. So go ahead, plan on finding an option that meets your needs. 

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