Health coverage
Understanding your health coverage
What your plan actually asks of you
10 min workbook
Why this matters
Health coverage is one of the largest financial exposures most households carry, and one of the least examined.
Understanding a few terms makes your own plan documents readable.
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Key terms
- Premium
- The amount paid for coverage.
- Deductible
- The amount you may be responsible for before certain plan benefits apply.
- Copay
- A fixed amount you may pay for a covered service.
- Coinsurance
- A percentage share of costs you may be responsible for.
- Out-of-pocket maximum
- A limit on certain covered costs during a plan year, as defined by the plan.
- Network
- The providers and facilities your plan has contracted with. Plan rules about out-of-network care vary.
The lowest premium is not automatically the lowest total cost. Total cost depends on premiums, deductibles, cost sharing, network rules and how much care you actually use.
A simple coverage check
Can you answer each of these from your own documents?
If you are approaching or over 65
Medicare is a federal health insurance program. Eligibility commonly relates to age 65 or older, and in certain cases to disability, End-Stage Renal Disease, or ALS.
Enrollment timing rules vary by situation, and choices made at enrollment can have long-term effects.
WORKWELL does not recommend a specific Medicare product or plan. If you want help understanding your situation, you can request Medicare help and no one will try to sell you anything.
If you are under 65 and need coverage
If you are uninsured or reviewing options, you can explore health coverage options through the destination WORKWELL has configured for participants.
Reviewing options is educational. Nothing here determines your eligibility or cost.
What you've heard vs. what you should know
What you've heard
“The cheapest plan saves me the most money.”
What you should know
Total annual cost includes cost sharing and how much care you use, not just the premium.
What you've heard
“If I have insurance, care is covered.”
What you should know
Coverage depends on plan terms, network rules and cost sharing.
What you've heard
“I can sign up for coverage any time.”
What you should know
Enrollment periods and qualifying events apply, and rules differ between programs.
Start here
Find your Summary of Benefits and Coverage, or the equivalent plan summary for your coverage, and read the cost-sharing section.
30-day WORKWELL challenge
0 of 6Reflection
Three things I did not know about my coverage:
Your next step
Keep your plan summary somewhere you can find it quickly — the moment you need it is rarely a calm one.
If something in your documents doesn't make sense, send WORKWELL the question.