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HMO (Health Maintenance Organization): Requires members to choose a primary care physician (PCP) and obtain referrals to see specialists. Coverage is typically limited to providers within the HMO network. PPO (Preferred Provider Organization): Offers more flexibility, allowing members to see any healthcare provider without a referral, both in-network and out-of-network, though out-of-network services may come with higher costs.

Coinsuranceis your share of the costs of a covered healthcare service, calculated as a percentage (e.g., 20%) of the allowed amount for the service. You start paying coinsurance after you've paid your plan's deductible. For example, if your plan's allowed amount for a service is $100 and you've met your deductible, your 20% coinsurance payment would be $20.

Affordable Care Act (ACA) Plans – Available during Open Enrollment (Nov. 1 – Jan. 15) or with a Special Enrollment if you lose coverage. Short-Term Health Insurance – A temporary plan for gaps in coverage, like between jobs or waiting for new benefits. Health Care Sharing Programs – A faith-based, non-traditional coverage option.

Medicaredoes not typically cover long-term care services, such as custodial care in a nursing home or assisted living facility. However, it may cover short-term skilled nursing care or rehabilitation services after a hospital stay. For long-term care coverage, individuals often consider Medicaid or private long-term care insurance policies.

You may qualify for a Special Enrollment Period if you experience certain life events, such as: Losing existing health coverage (e.g., job-based, individual, or student plans). Moving to a different ZIP code or county. Experiencing changes in your household (e.g., marriage, divorce, birth of a child). Becoming eligible for Medicaid or the Children's Health Insurance Program (CHIP).

Original Medicare does not cover routine dental care, eye exams, glasses, hearing aids, or fittings. You can purchase standalone dental, vision, and hearing plans or choose a Medicare Advantage plan that includes extra benefits.

If you're already receiving Social Security benefits, you’ll be automatically enrolled in Medicare Part A and Part B, and your card should arrive about 3 months before your 65th birthday. If you’re not receiving Social Security yet, you’ll need to manually enroll through Social Security (online, by phone, or in person).