Once you’ve applied for individually purchased non-Medicare health care coverage and made your first month’s payment, you’re issued a health plan policy with a date that indicates when your coverage will start. Each month, you pay a premium, which is a monthly bill for your health plan. While you’re responsible for your premium, you may qualify for help from the government to pay part of your premium. This financial assistance is called an advanced premium tax credit or subsidy. The government will send the subsidy directly to the health insurance company, which lowers the cost of your monthly payment.

Most plans have a deductible, which is how much you need to pay out of your pocket each year before your health plan begins to pay its share. The deductible may apply to all covered services, or it may only apply to selective covered services, depending on your plan. Your plan may start covering a primary care doctor visit right away while an inpatient stay to the hospital may only be covered after you pay the amount of the deductible. You also may have to pay part of the cost for some covered services even if you meet your deductible. This is called your cost share and can include things like copayments or copays (which are flat fees that you may pay for covered health services) or coinsurance (which is a percentage of a covered medical bill). Most health plans will have a network, or a list of doctors, hospitals and other health care providers that you can choose from. These are called in-network health care providers. Going to these providers when you need care will generally save you the most money. If you go to a provider that is not in your plan’s network, you may have to pay more.

Some plans, such as HMO plans, only cover services by in-network providers. Other plans, like an EPO, require that you use exclusive providers for certain covered services, such as prescription drugs or medical equipment. Learn more about the different types of health care plans.

Your plan will have an annual out-of-pocket maximum, which is the most you’ll pay each year for services covered by your health insurance plan. After you’ve paid this amount, your insurance pays 100% of covered medical expenses for the rest of the calendar year. 

Health insurance plans can also come with perks that come at no extra cost to you, like health and wellness rewards programs and discounts for services and products.