Aspectos básicos del seguro

What is Health Insurance?

Health insurance is a kind of insurance coverage that covers medical expenses for illnesses, injuries, and medical conditions. It can reimburse you for expenses, or pay your care provider directly.

 

Choosing an affordable health insurance plan that meets your needs can be complicated. We put together these guidelines so you can find a plan that works for you and make the most of your coverage.

How Do I Pick the Best Health Insurance Plan for Me?

Americans get health insurance in many different ways, with most of us choosing from one of the following options:

  • Federal and state health insurance marketplaces

The federal government operates the Health insurance Marketplace (available at HealthCare.gov) for most states. Some states run their own Marketplaces. “The Marketplace or “exchange” provides health plan shopping and enrollment services through websites, call centers, and in-person help.

New Yorkers can access affordable federal and state health insurance options through its own Marketplace, as well as Medicare Advantage and Medicare Supplement, Medicaid, and HARP and CHPlus.

  •  Private health insurance marketplace

Private health insurance exchanges are usually designed to serve several large employers, so most people will only encounter them when signing up for job-based health insurance.

  •  Empleadores

Employer-sponsored health insurance is a health policy selected and purchased by your employer and offered to eligible employees and their dependents in what are usually called “group plans."

  • Know your personal health needs. Being aware of the medical history, prescription medications, and health care goals of everyone you’re seeking coverage for will help you balance your costs with your coverage needs.
  • Know who is being covered. At EmblemHealth, we offer Individual and Family Plans.
  • Find out if you qualify for lower-cost coverage.
  • Visit our FAQ.

With the right information and research, you can compare the available plans to find one that works best for you.

  • Master some basic health insurance terms
    • Copago: A fixed amount paid by a patient for receiving a particular health care service, with the remaining balance covered by the person's insurance company.
    • Deductible:  A fixed amount a patient must pay during a given time period, usually a year, before their health insurance benefits begin to cover the costs.
    • In-network: When a doctor, hospital or other provider accepts your health insurance plan we say they’re in-network. We also call them participating providers.
    • Fuera de la red: When you go to a doctor or provider who doesn’t take your plan, we say they’re out of network.
    • Premiums: The amount of money an individual or business pays for an insurance policy.
    • Coseguro: El porcentaje de los costos de un servicio de cuidado de la salud cubierto que usted paga después de haber pagado su deducible.
  • Ver planes. Check benefits and out-of-pocket costs for our standard and nonstandard "metal plans" (Platinum, Gold, Silver and Bronze), catastrophic option (Basic), $0 or $20 Essential Plans, and new adult dental and vision options.
  • Read benefits summaries. At EmblemHealth, we’ve included benefits summaries to plan descriptions so you can understand plan benefits at a glance.  

Viva de lo mejor

Estamos aquí para ayudarlo

Sabemos que conservar la salud vale la pena. Es por eso que ofrecemos una variedad de programas y recursos para ayudarlo a mantenerse en forma, hacerse cargo de su salud y mejorar su calidad de vida.