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Your guide to understanding how health insurance works.
Health insurance is an insurance product designed to cover medical expenses. Medical expenses include, but are not limited to, preventative care, emergency services, surgeries, and prescription medication. Health insurance is similar to other types of insurance in that you pay a monthly premium in order to access the plan.
Health insurance doesn't always cover all of your medical costs; your total out-of-pocket costs may include your deductible the amount you have to spend before health insurance kicks in), your copayments (a fixed amount you pay for certain services or medication), and your coinsurance (a percentage of the cost that you pay for certain services or medication).
In order to be considered "qualifying health coverage" as defined by the Affordable Care Act, a health insurance plan must have the minimum essential coverage (MEC). All plans purchased through the marketplace need to meet these requirements. To meet MEC requirements, plans need to follow all new rules and regulations laid out by the Affordable Care Act, including the ten essential health benefits, affordability standards, and guaranteed coverage of pre-existing conditions.
All health insurance plans have a maximum out-of-pocket limit that limits that amount you have to spend on medical expenses every year. The maximum out-of-pocket limit for 2019 is $7,900 for individual plans and $15,800 for family plans.
For 2019 health insurance plans, there is no individual mandate tax penalty.
Policygenius’ editorial content is not written by an insurance agent. It’s intended for informational purposes and should not be considered legal or financial advice. Consult a professional to learn what financial products are right for you.
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Yes, we have to include some legalese down here. Read it larger on our legal page. Policygenius Inc. (“Policygenius”) is a licensed independent insurance broker. Policygenius does not underwrite any insurance policy described on this website. The information provided on this site has been developed by Policygenius for general informational and educational purposes. We do our best efforts to ensure that this information is up-to-date and accurate. Any insurance policy premium quotes or ranges displayed are non-binding. The final insurance policy premium for any policy is determined by the underwriting insurance company following application. Savings are estimated by comparing the highest and lowest price for a shopper in a given health class. For example: for a 30-year old non-smoker male in South Carolina with excellent health and a preferred plus health class, comparing quotes for a $500,000, 20-year term life policy, the price difference between the lowest and highest quotes is 60%. For that same shopper in New York, the price difference is 40%. Rates are subject to change and are valid as of 2/17/17.
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