Health Insurance 101: What You Need to Know

Health insurance is one of the most important financial tools available to you and your family. Yet for many people, the terminology and options can feel overwhelming. At GRIT ADVISORS, we believe everyone deserves to understand their coverage options. Here's a straightforward guide to health insurance basics.

Key Terms You Should Know

• Premium: Your monthly payment to maintain coverage, whether or not you use medical services.

• Deductible: The amount you pay out-of-pocket before insurance kicks in. Example: with a $2,000 deductible, you pay the first $2,000 of covered care each year.

• Copay: A fixed fee for specific services (e.g., $30 per doctor visit) paid after meeting your deductible.

• Coinsurance: Your share of costs after the deductible — typically 20% while insurance covers 80%.

• Out-of-Pocket Maximum: The most you'll ever pay in a plan year. Once you hit this limit, your insurer covers 100% of covered services.

• Network: Doctors and hospitals that have contracted with your insurer for discounted rates. Staying in-network saves you significant money.

Types of Health Insurance Plans

• HMO (Health Maintenance Organization): Requires a primary care physician and referrals for specialists. Lower premiums, less flexibility.

• PPO (Preferred Provider Organization): See any doctor without a referral. Higher premiums but maximum flexibility in choosing providers.

• EPO (Exclusive Provider Organization): No referrals needed, but coverage is limited to in-network providers except in emergencies.

• HDHP (High-Deductible Health Plan): Lower monthly premiums with higher deductibles. Can be paired with an HSA (Health Savings Account) for tax advantages.

Where to Get Health Insurance

• Employer-Sponsored Coverage: Many employers offer group plans with shared premiums — often the most affordable option.

• ACA Marketplace (Healthcare.gov): Individual/family plans available during Open Enrollment (Nov 1 – Jan 15). Income-based subsidies may significantly reduce your premium.

• Medicaid: Free or low-cost coverage for individuals and families who meet income requirements. Eligibility varies by state.

• Medicare: Federal health coverage for people 65+ or those with qualifying disabilities. Includes Parts A, B, C, and D.

Need Help Choosing a Plan?

Navigating health insurance options can be complex — but you don't have to do it alone. At GRIT ADVISORS, we work with individuals, families, and small businesses to find the right plan at the right price. Contact us today for a free, no-obligation consultation.