Health insurance basics

What is health insurance?

Health insurance helps you pay for medical care and can protect you from high health care costs, like emergency room visits or hospital stays. Having health insurance gives you access to preventive care and provides a safety net when unexpected medical emergencies happen.

What does health insurance cover?

Health insurance plans on the Marketplace must help pay for these 10 essential health benefits:

  1. Outpatient care: care you get when you don’t have to stay overnight in a hospital or other health care facility, such as doctor visits and same-day surgery, like getting your tonsils removed.
  2. Trips to the emergency room.
  3. Inpatient care: care you get when you stay overnight in a hospital or other health care facility, like if you have surgery or a serious medical condition.
  4. Care before and after your baby is born: care women get while they’re pregnant, during labor and delivery, and care for newborn babies.
  5. Care for mental health and substance: care you get to diagnose and treat mental health conditions, substance abuse or addictions, like treatment for depression or alcohol abuse.
  6. Prescription drugs: medicines your doctor prescribes or orders for you.
  7. Services and devices to help with daily living: services and devices that help you if you have a disability or long-term condition or need to recover from an injury, like physical therapy and walkers.
  8. Laboratory tests: tests that help doctors diagnose or treat an injury or health problem, like x-rays or blood tests.
  9. Free preventive care: routine health care you get to help prevent sickness, disease, or other health problems, like cancer screenings and wellness and well-woman checkups.
  10. Care for children up to age 19: care children get like health checkups, dental checkups, vision tests, and hearing tests.

How does health insurance work?

Here are the basic steps of how to use your health insurance.