Similar to how auto insurance covers the car in the case of an accident, health insurance covers individuals when they are injured or sick. Health insurance is defined as the product that covers the whole or a part of an individual’s medical expenses. As medical costs are considered very high for the average person to cover out of pocket, it is highly beneficial to have health insurance.

Generally speaking, there are two types of health insurance: public health insurance, including Medicaid, CHIP (Children’s Health Insurance Program) and Medicare, and private health insurance that an individual can get from an employer or purchase on the marketplace. Both federal and state exchanges provide consumers with private health insurance and public health insurance.

An on-exchange health insurance plan includes policies covered on a government-run exchange, while an off-exchange health plan is directly sold by a third party broker or a health insurance company. Employer-provided health insurance, also known as group plans, are private health plans purchased by the employer. Short-term health insurance plans provide consumers with coverage for a short coverage gap.

In addition to the above, Medicare is a federal health insurance program that provides free healthcare for Americans aged 65 and older. Medicaid is a federal and state health insurance program that is designed for low-income families and individuals. Like Medicaid, CHIP is also a state and federal health insurance program but is specifically designed for children under 18 whose family incomes are too low to afford private health insurance and too high to be eligible for Medicaid.

That being said, regardless of the health insurance plan bought by an individual, there are ten essential benefits that every health insurance plan must provide for its consumers. These ten essential benefits are:

  • Ambulatory patient service, which includes outpatient care without being admitted to the hospital
  • Emergency services
  • Maternity, pregnancy, and newborn care
  • Hospitalization, which provides for overnight stays and surgery
  • Mental health and substance use disorder services, which includes counseling, psychotherapy, and behavioral health treatment
  • Laboratory services
  • Prescription drugs
  • Pediatric services, which also includes vision and oral care
  • Preventive and wellness services, in addition to chronic disease wellness
  • Habilitative and rehabilitative services and devices

Regardless of insurance company or policy, these services are required coverage. 

While most individuals receive their health insurance coverage through their employer, there are certain situations where this is not the case. Part-time employees are often left to find their own health insurance coverage, as are those who may be self-employed. For these individuals, Enrollment First, Inc. offers affordable benefits to meet the needs of every client. Our services are served a-la-carte to participants and employees so that they can select as much or as little coverage as their lifestyle demands. For more information, please visit EnrollFirst.com.