How health insurance works

How does insurance work?

No matter which plan you choose, you’ll pay a monthly payment (premium) to keep your health insurance coverage. You may also pay each time you receive medical care (co-payment) or (co-insurance). Generally, the more you pay per month (premium), the lower your deductibles and out-of-pocket costs.

When you’re looking at health insurance plans, the biggest differences are in the services they cover and how much they’ll pay for those services. With some plans, you’ll pay a certain amount when you have a service – that can be called a co-payment or coinsurance, depending on your plan.

If you have a deductible, that’s the amount you’ll have to pay for covered services before the insurance starts paying.

Most of the time, you’ll pay for part of your health care services until you’ve paid the “out of pocket maximum.” After that, the health insurance usually pays for covered expenses.

Things to know

We know health care can be confusing. This Health Care 101 video explains the basics of how health plans work.

When can I enroll?

Most of the time, you may enroll only during an open enrollment period. If you’re between open enrollment periods, you might be eligible for special enrollment. Take a look at the list of qualifying life events - including marriage, birth of a baby, change of address, job change and more – to see if this option will work for you. Another option might be Short Term Health Insurance, which can bridge a gap in coverage until the next open enrollment period.

How much is health insurance?

It’s easy to find out —just follow these three steps:

  1. Enter your ZIP code.
  2. Fill in general information.
  3. View short term health, dental, vision plans and more in your area.

If you’re looking for ACA plans from the Health Insurance Marketplace or have questions, call 800-980-5213.

Estimate costs before you buy

Compare out-of-pocket costs for different health plans before you choose.


No individual applying for health coverage through the individual Marketplace will be discouraged from applying for benefits, turned down for coverage or charged more premium because of health status, medical condition, mental illness claims experience, medical history, genetic information or health disability. In addition, no individual will be denied coverage based on race, color, religion, national origin, sex, sexual orientation, marital status, personal appearance, political affiliation or source of income.

Short Term Medical plans are medically underwritten and do not provide coverage for preexisting conditions or meet the mandated coverage necessary to avoid tax penalty under the Affordable Care Act (ACA). Expiration or termination of a Short Term Medical℠ plan does not trigger an ACA Special Enrollment opportunity.

References to UnitedHealthcare pertain to each individual company or other UnitedHealthcare affiliated companies.

Each company is a separate entity and is not responsible for another's financial or contractual obligations.

Administrative services are provided by United HealthCare Services, Inc.

Products and services offered are underwritten by Golden Rule Insurance Company, Oxford Health Insurance, Inc. and UnitedHealthcare Life Insurance Company.

In New Mexico, products and services offered are underwritten only by Golden Rule Insurance Company.

All products require separate applications. Separate policies or certificates are issued. Golden Rule Short-term MedicalSM plans are medically underwritten. Related insurance products offered by either company may be medically underwritten—see the product brochures and applications. Healthiest You is not an insurance product and is provided by HY Holdings, Inc., d/b/a Healthiest You. Travel Health Insurance and Pet Insurance are underwritten by different companies that are not related to the UnitedHealthcare family of companies. Product availability varies by state.