Key Points
Health insurance (also called health coverage or a health plan) helps you pay for medical care.
Having insurance is important to cover the costs of checkups, treatments, and hospital visits for you and your family.
There are different types of health plans, and choosing the right one depends on your medical needs, budget, and whether you’re pregnant or planning to get pregnant.
Where can you get health insurance?
Your health insurance options depend on where you live and how much money you make. You may get coverage through:
- Your employer or your partner’s employer
- A private insurance company
- Government programs, such as:
- Medicaid
- Children’s Health Insurance Program (CHIP)
- The Health Insurance Marketplace
To find out what plans are available to you, visit your state’s Health Insurance Marketplace.
What should I look for in a health insurance plan?
Not all health plans cover the same services, and costs can vary. When comparing plans, think about what medical care you and your family may need over the next year. Keep these in mind:
- Premium. This is the amount of money you pay each month for insurance.
- Deductible. This is the amount of money you have to spend before the plan starts paying for your healthcare. For example, if you have a $500 deductible, you have to spend $500 on healthcare before your plan will pay.
- Co-payment (also called co-pay). This is the amount of money you pay for each healthcare service, like a visit to a healthcare provider.
- Maximum out-of-pocket cost or expense. This is the highest amount of money you would have to pay each year for healthcare services.
What healthcare providers do insurance plans cover?
Each health plan has a network (group) of healthcare providers, including doctors, hospitals, and specialists. Here’s what to look for in a health plan when checking your provider options:
- Preferred providers. These providers have a contract (agreement) with a health plan to provide medical services to you at a discount. They are considered “in-network”. In many cases, going to a preferred provider is the least expensive way to get healthcare.
- Participating providers. These providers accept the plan, but are likely “out-of-network" and you may have to pay more for services.
- Tiered network. This means a health plan has different costs for different providers. You may have to pay more to see some providers than others.
If you have a preferred healthcare provider or hospital in mind, check if they’re covered under the plan before choosing.
What healthcare services do insurance plans cover?
Under the Affordable Care Act (also called ACA) health plans must cover certain services, especially if you’re pregnant, thinking about getting pregnant or have children. These include:
- Regular health checkups. These checkups are really important before you get pregnant to help make sure you’re healthy when you get pregnant.
- Prenatal care. This is medical care you get during pregnancy, including screenings and checkups.
- Labor and delivery. This is care you get for childbirth at hospitals or birthing centers.
- Well-baby and well-child checkups. These are checkups your child gets when not sick. These services are covered for babies and children.
When choosing an insurance plan think about the medical needs you and your family may have. Check to make sure that the care you need is covered before selecting a plan.
Where can you get help choosing a plan?
Finding the right insurance plan can be confusing. A Navigator is a trained professional who helps people compare plans and understand their options. They can also help with applications and checking if you qualify for financial assistance.
You can speak with a Navigator 24/7 at www.healthcare.gov/contact-us or call (800) 318-2596.
What about employer-based health insurance?
Many people get health insurance through their job or their partner’s employer. If your employer offers coverage, it may be your best option.
Under the Affordable Care Act (ACA), an employer’s health plan is considered affordable if it costs less than 9.12% of your household income (as of 2023).
- If your employer’s plan is affordable, you can still buy insurance from the Marketplace, but you won’t qualify for financial assistance.
- If your employer’s plan is too expensive, you may qualify for Medicaid or tax credits to help pay for a Marketplace plan.
Check your employer’s insurance costs and coverage before deciding. If you need help, talk to your HR department or check healthcare.gov.
What if you’re unemployed, self-employed, or can’t afford insurance from your employer?
If you don’t have job-based insurance or it’s too expensive, the Health Insurance Marketplace can help you find an affordable plan.
Financial help for health insurance
The Marketplace determines how much financial help you qualify for based on:
- Your annual income
- How many people live in your household
- Whether your employer offers affordable coverage
Examples of coverage options:
- In states that expanded Medicaid, you may qualify if your income is below 138% of the federal poverty level (about $20,120 for an individual in 2023). Income limits vary by state, so check your state’s rules.
- If you are unable to get covered by Medicaid, you may qualify for help paying for insurance premiums and other costs.
- If your household income is above a certain level, you won’t qualify for financial help (for example, a family of three earning over $83,250 may not qualify for tax credits).
To check your options and apply for insurance, visit www.healthcare.gov.
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Show Your Love Preconception Health
Last reviewed February 2025