Health insurance explained
Learn about the different plans available so you can choose the best one for you and your family
It’s important to have health coverage so you are covered for any illness or injury and have help to pay for medical costs. Health insurance covers expenses for unexpected care and helps maintain your health through preventive care.
There are several ways to get health insurance:
- Through your employer. In this case, the employer helps pay for the plan.
- On your own. You can contact an insurance company directly to purchase a plan.
- Through the Affordable Care Act (ACA). The ACA offers a marketplace for you to search for and compare health insurance plans.
The key is to understand your needs and match them with the type of insurance that best suits you.
Depending on the plan you choose, this could include some or all the costs of:
- Visits to urgent care centers
- Hospital stays
- Annual and preventive checkups
- Other medical needs
Private health insurance
This is the most used type of health insurance because it’s offered through an employer or bought independently through other insurance companies. To keep costs low, some private insurance plans work with specific healthcare providers and facilities. These are part of the plan’s network.
This type of care falls into two categories:
- Health Maintenance Organizations (HMOs) - With a typical HMO plan, you are covered for care from providers in your network only. A referral from your primary care physician (PCP) is required to see a specialist. You usually pay less than for other plans but an HMO may have a smaller network of providers.
- Preferred Provider Organizations (PPOs) - With a PPO plan, you have the flexibility to see any doctor that you want – inside or outside your plan’s network – but your costs will be higher when receiving services from non-network providers. If the service isn’t covered, you may be responsible for all billed charges. When you stay in your plan’s network, you save more. Also, you are not required to see a PCP and you do not need a referral to see a specialist.
Two government insurance programs fall under this category: Medicaid and Medicare. Both help eligible people cover their medical expenses.
- Medicaid - This insurance program is provided state-by-state and helps lower-income people pay for their medical care. It is available only to low-income families and single people who qualify. Requirements differ depending on the state where you live. The program covers most medical care by reimbursing the provider directly. Enrollees may have to pay a small amount for certain care.
- Medicare - Similar to Medicaid, this program is government-run but on the federal level. It provides access to healh care for people age 65 and up and covers some medical costs for people who qualify. People who have certain disabilities or health issues may also qualify. This includes those who suffer from chronic kidney failure who are on dialysis or need a transplant.
© Blue Shield of California 1999-2023. All rights reserved. Blue Shield of California is an independent member of the Blue Shield Association.
Blue Shield of California is an HMO and PDP plan with a Medicare contract. Enrollment in Blue Shield of California depends on contract renewal.
This information is not a complete description of benefits. Call Member Services at (800) 776-4466 (TTY: 711) for more information.
The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
Blue Shield of California complies with applicable state laws and federal civil rights laws, and does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, or disability.
Blue Shield of California cumple con las leyes estatales y las leyes federales de derechos civiles vigentes, y no discrimina por motivos de raza, color, país de origen, ascedencial, religión, sexo, estado civil, genero, identidad de genero, orientación sexual, edad ni discapacidad.
Blue Shield of California 遵循適用的州法律和聯邦公民權利法律，並且不以種族、膚色、原國籍、血統、宗教、性別、婚姻 狀況、性別認同、性取向、年齡或殘障為由而進行歧視。
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