health insurance

What is health insurance?

  • Health insurance – also referred to as medical insurance or health care insurance – refers to insurance that covers the cost of a policyholder’s medical expenses. How much the insurance covers – and how much the policyholder pays – depends on the specifics of the policy itself, with specific rules and regulations that apply to some plans.
  • Types of insurance include individual health insurance, employer-sponsored group health insurance (both large-group and small-group), Medicare, Medicaid, CHIP, Tricare and insurance for government employees (FEHB).
  • Health insurance is regulated at both the state and federal level. States can impose various requirements and mandates that go beyond basic federal requirements, but only for fully insured health plans. Self-insured health plans are regulated at the federal level, under ERISA, and are not subject to state insurance regulations (so for example, if a state requires health insurance plans to include coverage for treatment of infertility, that mandate would not apply to self-insured group plans in the state).
  • Individual health insurance includes ACA-compliant health insurance – which is major medical insurance that was mandated by the law to include essential health benefits and offer coverage on a guaranteed-issue basis – as well as grandmothered and grandfathered plans (no longer sold to new enrollees, but still in force for people who have opted to keep them).
  • Health insurance also includes coverage that isn’t compliant with the ACA, such as short-term health insurance and other condition-specific and disease-specific coverage such as cancer insurance. These plans are available for purchase in most states, but are generally not adequate as a permanent stand-alone insurance solution.

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