Different Types of Health Insurance
If you're looking for a place to start learning more about insurance, this is it.
This guide covers the main types of private and public coverage, including employer plans, the ACA marketplace, Medicare, Medicaid, CHIP, TRICARE, and IHS.
You’ll learn what each one is, who provides it and who may qualify, so you know where you might want to dive in deeper.
What is Private (general) Insurance?
What is it? A contract between yourself and a private health insurance provider that mandates they pay all or some of your covered health care expenses as long as you pay your premium and meet your deductible.
Who provides it? The Affordable Care Act (ACA) marketplace or Private Health Insurance Companies
Who may qualify? In general, persons who reside in the state they seek to purchase health insurance in, are U.S. citizens, and are not incarcerated may be eligible to purchase a health insurance plan from the ACA marketplace.
Examples Blue Cross Blue Shield, Kaiser Permanente, or United Healthcare plans offered through the ACA marketplace via Healthcare.gov or purchased directly from the company.
What is Employer-Based (General) Insurance?
What is it? A contract offered as a part of your employment benefits package between yourself and your employer that mandates they pay all or some of your covered health care expenses as long as you pay your premium and meet your deductible.
Who provides it? Your employer
Who may qualify? In general, employees who have worked for a certain amount of time and met the waiting period requirement may be eligible for a health
insurance plan.
What is Public (General) Insurance?
What is it? Health insurance provided by the state or federal government.
Who provides it? The state or federal government
Who may qualify? Eligibility requirements differ widely among various public health insurance programs making overall generalizations difficult.
Examples: Medicare, Medicaid, or Children's Health Insurance Program (CHIP)
What is Medicare?
What is it? A federal health insurance program that offers health insurance coverage to adults aged 65 years and older, certain younger people with disabilities, and people with permanent kidney failure that requires dialysis or a
kidney transplant.
Who provides it? The federal government
Who may qualify? Adults aged 65 years and older, certain young adults with certain disabilities, and people with permanent kidney failure that requires
dialysis or a kidney transplant.
Examples Original Medicare and Medicare Advantage.
What is Medicaid?
What is it? A joint state and federal government health insurance programs that
provides health insurance coverage to certain persons including eligible low-income adults, people with disabilities, elderly people, children, and pregnant women.
Who provides it? The State and Federal Government (Medicaid is a joint state
and federal government program where requirements differ by state).
Who may qualify? U.S. citizens (or persons that meet Medicaid citizenship requirements) that meet certain limited income and resource thresholds. However, eligibility requirements vary widely from state to state. Meet with someone from your state or county Medicaid office to determine if you qualify in your state.
What is Children's Health Insurance Program (CHIP)?
What is it? A government health insurance program that
provides low-cost health insurance coverage to children in families that
earn too much money to qualify for Medicaid, but are within the income
requirements for the program. CHIP also provides coverage to eligible pregnant women in some states.
Who provides it? The State and Federal Government (CHIP is a joint state
and federal government program where requirements differ by state).
Who may qualify? Eligibility requirements vary widely from state to state. Apply for CHIP to determine if you qualify in your state.
What is Tri-Care?
What is it? A government-managed public health care program
that offers insurance coverage current and former service members,
and their families such as active duty service members (ADSMs), active
duty service family members (ADSFMs), National Guard members, and National Guard family members.
Who provides it? The Federal Government
Who may qualify? Persons who are active duty, retired Uniformed Service members, and National Guard or Reserve members may be eligible. Persons who are the spouse or child of someone who is active duty or a retired Uniformed Service member may be eligible. Persons who are the spouse of child of someone who is a National Guard or Reserve member may be eligible. Persons who are the spouse of a deceased military member or are the former spouse of a military member may be eligible. Persons who are a Medal of Honor recipient or are the spouse or child of a Medal of Honor recipient may be eligible. Persons who are registered in the Defense Enrollment Eligibility Reporting System (DEERS) may be eligible.
Examples: TRICARE Prime, TRICARE Prime Remote, TRICARE Prime Overseas, TRICARE Prime Remote Overseas, TRICARE Select TRICARE Select Overseas, TRICARE for Life,
TRICARE Reserve Select, TRICARE Retired Reserve, TRICARE Young Adult, and US
Family Health Plan.
What is Indian Health Service (IHS)?
What is it? The IHS is a federal agency that provides health services directly to Native Americans and Alaska Natives. IHS allows eligible persons to access to enroll in qualified health plans through the ACA Marketplace or access coverage through Medicare, Medicaid, or the Children's Health Insurance Program (CHIP).
Who provides it? N/A. The IHS is NOT a health insurance plan type, but is a federal program that can help eligible persons access health insurance coverage and health services.
Who may qualify? Persons who are Native American or Alaskan Native.