Health Insurance and Its Importance

Jan was always a healthy individual. She played sports in high school, always passed annual physicals, and rarely took sick days. Because she was healthy, when her parents' insurance dropped, she didn't look for health insurance.

During her second year of college, Jan got very sick with what her mother called the flu. But days turned into weeks, and Jan was still sick. With no coverage, and no money to pay a hospital or clinic, Jan missed class after class.

Finally, a professor informed her that the campus clinic was free to students! Jan made an appointment as soon as she could and was able to get blood work. She was diagnosed with a serious vitamin deficiency, which was easily treatable.

Jan's story is all too familiar to Americans today. Healthy Americans feel they don't need insurance, especially those aged 19-25. Unfortunately, this is the time when many major illnesses and diseases are diagnosed. Most mental health disorders become prominent and noticeable in the early twenties. Among other diseases, conditions like type 1 diabetes, thyroid disorders, and even deadly allergies are commonly diagnosed in young adults. Many life-threatening circumstances can be avoided if healthy people have insurance.

Advantages of Having Health Insurance

1. Keeping Healthy People Healthy

Many people don't understand the importance of health insurance because they simply don't know what it can do for them. The U.S. Office of Disease Prevention and Health Promotion strives to improve access to healthcare. When Americans have health insurance, they have better access to quality care that will impact their physical, social, and mental health for the better.

2. Preventative Services

Insurance companies don’t like to waste money, so when you pay for an insurance policy, it will cover evidence-based preventative measures to prevent illness by:

Promoting healthy behaviors.
Protecting those most at risk.
Identifying and treating those most at risk before they develop an illness.

3. Establishment of a Primary Care Provider

Your insurance policy will likely cover specific physicians that are "in network." Establishing a primary care provider cultivates an ongoing health relationship in which the physician knows your medical history well and can better treat you if problems crop up.

4. Coverage For Essential Health Benefits

Health insurance covers medical expenses, such as doctor visits, hospitalizations, surgeries, medications, ambulance costs, and other healthcare services. It helps you pay for these costs without using your savings or taking on a debt.

5. Access to a Network of Health Providers

Specialized care from a network of providers is covered by most health plans. Your primary care provider can refer you to a specialist if you need one. Health insurance ensures you get timely medical attention and enjoy high-quality healthcare.

6. Protection from Financial Ruin

Though health insurance comes with a cost, it protects a healthy person from financial ruin in the event of a devastating illness. Financial responsibility often keeps individuals from seeking care, and financial stress can also take away from the healing process.

Health insurance is the net that stretches far and wide below the tightrope that Americans walk every day. There can be holes in the net, and policy loopholes that we don't know exist or don't understand. There may be a policy change that we aren't ready for, but it's important that the policy is there.

Remember, you’re only healthy until something happens. Accidents happen, genetics catch up with us, metabolism slows down, and germs abound. The old adage is true: an ounce of prevention is worth a pound of cure.

7. Peace of Mind Through Coverage

Health insurance pools the resources and risks of a large number of people so that each person is protected from financially disruptive medical expenses related to an illness, accident, or disability.

Disadvantages of Health Insurance

1. Costs of Health Plans

As expected, the biggest disadvantage of health insurance is the cost. This is especially true if you have existing medical conditions and do not have access to any kind of group coverage. The monthly premiums for many individual policies are several hundred dollars, with family coverage costing even more. Additionally, even the more comprehensive policies come with deductibles and copays, which means you have to pay for your medical expenses before insurance coverage kicks in.

2. Coverage Issues

You are responsible for all or part of your medical expenses until you meet the deductible for your coverage year. This means you will have to pay a certain amount out-of-pocket for medical expenses each year, even if you have health insurance.

Many health insurance policies don't cover all diseases and conditions. If you fall into one of the gaps written into your health policy by the insurers, you have to pay out-of-pocket for medical services related to that specific condition.

Denials of coverage by the insurance company for treatments recommended by your doctors or billing errors can leave you footing the bill for your medical care if you don’t challenge them with the insurer.

Affordable Options for Health Plans

Best Options For Low-Income Individuals

The best options for low-income individuals to get health coverage are to check if they can save on Marketplace premiums or qualify for Medicaid or the Children’s Health Insurance Program (CHIP). You can get exact prices by filling out the Marketplace application.

Comparing Insurance Plans For Cost-Effectiveness

The savings you can make on health coverage depend on the state you reside in, your marital status, and the number of tax dependents.

For example, in North Carolina, an unmarried individual without any tax dependents who has an annual income of below $20,782 qualifies for free or low-cost health coverage through Medicaid. If they don’t qualify for Medicaid, they may qualify for savings on a Marketplace plan instead.

How To Obtain Health Insurance

Affordable Care Act (ACA)

The Patient Protection and Affordable Care Act (ACA for short) is a comprehensive healthcare reform law that was enacted in 2010. The main goals of the ACA are:

How Do I Apply For The Affordable Care Act?

Wait for the open enrollment period (November 1 to January 16 in most states).
Go to Healthcare.gov to find your state’s Health Insurance Marketplace.
Fill out an application. Provide your age, income, household size, and other information
Healthcare.gov will assess your eligibility and show you plans in your area
Choose a plan and enroll.
Make changes to your current plan if you already have health coverage.
Choose a new plan to replace your current plan if you want a different type of plan.
Use the special enrollment period to enroll in health coverage or switch plans if you experience a qualifying life event (for example, a change in place of living, a change in household size, or a change in Marketplace eligibility).

Understanding Coverage for Health Care Services

When you buy health coverage from an insurance broker or your state's Marketplace, you'll need to choose health plans organized by metal tier according to the benefits they offer. Bronze plans provide only essential health benefits, silver and gold plans provide more health coverage, and platinum plans offer the maximum coverage.

People under 30 can also choose a catastrophic plan—this type of plan has a low monthly premium but a high deductible. It provides minimum essential coverage for routine healthcare and covers you for catastrophic illnesses at a low monthly cost.

On average, the coverage for health care services by various plans is as follows:

Platinum covers 90% of your medical costs and you pay 10%
Gold covers 80% of your medical costs and you pay 20%
Silver covers 70% of your medical costs and you pay 30%
Bronze covers 60% of your medical costs and you pay 40%
Catastrophic plans pay after you reach the deductible, which is very high ($9,200 in 2025). These policies also cover the first three primary care visits and include free coverage for preventive care, even if you have not yet met your deductible.

Different plans (bronze, silver, gold, and platinum) also differ in terms of the share of costs they will pay. The deductible—the amount you will pay out-of-pocket before your plan pays any of your health care costs—varies from plan to plan. Generally speaking, the least expensive plans have the highest deductibles. But whatever plan you choose, they all have the same out-of-pocket maximum ($9,200 for individual coverage and $18,400 for family coverage in 2025).

After you have spent the out-of-pocket maximum on your deductible, copayments (fixed charges), and coinsurance (percentage of medical costs), your health plan will pay for 100% of your covered medical expenses.

Different Types of Health Insurance Plans

There are many insurance companies on the Marketplace, such as Aetna, Blue Cross Blue Shield, Cigna, Humana, Kaiser, and United.

Each of these insurance brands offers four common types of health insurance plans:

Health Maintenance Organizations (HMOs)

All healthcare services are delivered through the plan’s network of providers.
A primary care physician manages your healthcare and refers you to a specialist if you need one.
You need to pay the full medical bill out-of-pocket if you see any provider who is out of network.
HMOs involve the least amount of paperwork among the different types of plans.

Preferred Provider Organizations (PPOs)

You do not need a referral from your primary care doctor to see a specialist.
More freedom to see healthcare providers of your choice, including out-of-network providers.
Higher out-of-pocket cost for seeing out-of-network providers.
More paperwork is involved if you see out-of-network providers.

Exclusive Provider Organizations (EPOs)

Lower premium than a PPO.
No need for a referral from your primary care doctor to see a specialist.
Moderate freedom to see providers that are out of network.
You pay the full cost out-of-pocket if you see an out-of-network provider.
Little to no paperwork involved.

Point-of-Service (POS) Plans

Offer a blend of HMO and PPO features.
A primary care provider coordinates your care.
More freedom to see out-of-network providers.
You need a referral from your PCP to see a specialist.
Moderate paperwork is involved if you go out of network.

High-Deductible Health Plans (HDHPs)

Learn more: Choosing Health Insurance: HDHP Vs. PPO

Recognizing The Importance of Health Insurance

Social and Economic Impacts of Insurance Coverage

There is more to health insurance than simply reimbursing medical expenses. Health insurance promotes good health and creates financial security. It is one of the most effective ways to stay healthy and ensure high-quality medical care, including emergency care for unexpected medical complications and ongoing care for a pre-existing condition.

Health Insurance as a Human Right

Health care is a fundamental human right that applies to everyone, regardless of age, gender, race, religion, political beliefs, or socioeconomic conditions. The right to health is based on the fundamental idea that everyone should have access to health services when and where they need them, without suffering financial hardships. Health insurance is an integral part of the system that can ensure access to health care for all.

The Long-Term Benefits of Being Insured

There is a proven positive relationship between health insurance coverage and health-related outcomes. A large body of studies done using a variety of data sources and different analytical approaches have all shown that health insurance is linked to more appropriate use of health care services and better health outcomes for everyone.

Common Questions About Health Insurance

Why Do People Need Health Insurance?

People need health insurance for both health and economic benefits. Health insurance ensures a person receives preventive care to maintain health, medical care for chronic medical conditions and acute illnesses, as well as financial protection if a catastrophic illness or injury strikes.

Why Is It Important For Everyone To Have Insurance?

Everyone should have insurance to ensure high-quality health care when they need it as well as financial stability.

Is Health Insurance A Necessity?

Yes, health insurance is a necessity. It can promote preventive care and promote good health, ensure you get proper medical care for any medical problems, and protect you from financial ruin if a catastrophic illness or injury happens.

What Are The Legal Implications of Not Having Health Insurance?

There is currently no federal law that makes health insurance a legal requirement. However, some states in the U.S. require mandatory healthcare coverage. If you live in New Jersey, California, Rhode Island, Massachusetts, or the District of Columbia, you will have to pay a tax penalty if you don’t have health care coverage. Vermont recommends that all residents have coverage, but there’s no penalty for noncompliance.

How To Find the Least Expensive Insurance Option?

You can find the least expensive insurance option on your state’s Health Insurance Marketplace. If you are a low-income individual or family, Medicaid may be the most affordable choice if you meet the eligibility requirements.

How Much Is Basic Health Insurance Per Month?

The average costs of basic health insurance per month are as follows:

Tricare: $12
Medicare Advantage: $19
Employer-sponsored plan: $116
Medicare Part B: $175
Affordable Care Act (Marketplace) plan: $477

Is $200 A Month Expensive For Health Insurance?

Generally speaking, $200 a month is not expensive for health insurance, given that the average monthly premium on the ACA Marketplace is over $450. However, various factors such as your age, family size, where you live, metal tier, and type of plan can affect how much you pay for health coverage. So, while someone with Tricare coverage may pay only $12 in monthly premiums, a 60-year-old on a platinum ACA plan may pay more than $1,700 per month.

Which Is The Least Expensive Type of Health Insurance?

The following are the least expensive types of health insurance (depending on eligibility):

Medicaid, a government-funded program that offers free or affordable health insurance to low-income individuals and families.
Medicare, a government-funded program for US citizens and permanent residents 65 and older. Learn the difference between Medicaid and Medicare.
HMO plans that generally have lower premiums and deductibles than other plans and also fixed copays for doctor visits.
Bronze health plans from the ACA Marketplace that offer affordable health coverage at a low monthly premium.

How Do I Get Insurance When I Am Poor?

You can check your eligibility for Medicaid, a government-funded program that offers free or affordable health insurance to low-income individuals and families. If you do not qualify for Medicaid, you may be eligible for low-cost insurance plans for financially constrained individuals. Check your state’s Health Insurance Marketplace for cheap health insurance options.

How Much Does Health Insurance Cost A Month?

Health insurance costs can vary widely, ranging from under $20 to over $1,500. The average cost of an ACA Marketplace plan in the US is approximately $475 in monthly premiums.

What Is The Best Health Insurance?

There is no single best health insurance for everyone. The best health insurance depends on your age, health status, and other factors.

Is Health Insurance Even Worth It?

Health insurance is definitely worth it, even for young, healthy people with no pre-existing condition, because it offers preventive care and financial security. However, it’s important to carefully review the plan and choose the type of plan that is suitable for your age, family size, and health needs.

Is It Worth It To Not Have Health Insurance?

It is not worth the risk of not having insurance. Illnesses and accidents can strike anyone at any time. Not having insurance can lead to unmet medical needs, put your life at risk, and lead to financial ruin.

What Is The Goal of Healthy People 2030 Health Insurance?

The goal of Healthy People 2030 is to improve health by increasing medical, dental, and prescription drug insurance coverage. People without insurance are less likely to get the health care services and medications they need and more likely to have poor health outcomes.

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