Health Insurance

Health insurance helps protect individuals, families, and businesses from the financial impact of medical care. A health insurance policy may help pay for covered doctor visits, hospital care, prescriptions, preventive services, emergency care, and other eligible medical expenses.

Coverage depends on the policy or plan selected. Benefits, premiums, deductibles, copayments, coinsurance, provider networks, prescription drug coverage, exclusions, and eligibility vary by insurer, plan type, location, and state requirements.

Orion Financial Services LLC can help you review available health insurance options and understand how different plans may fit your needs.

What Health Insurance Can Help Cover

Health insurance may help pay for covered medical expenses, including doctor visits, preventive care, emergency services, hospital stays, prescription drugs, lab work, imaging, specialist visits, mental health services, maternity and newborn care, rehabilitation, and therapy services.

Actual covered services depend on the plan issued.

Individual and Family Health Insurance

Individual and family health insurance may be available through a state or federal health insurance marketplace, directly from an insurer, or through other approved enrollment channels.
Plans may vary by monthly premium, deductible, provider network, prescription coverage, out-of-pocket costs, and available benefits.
Depending on income, household size, and eligibility rules, some individuals and families may qualify for premium tax credits or cost-sharing reductions through the marketplace.

Employer and Small Business Health Insurance

Health insurance can also be offered through an employer or small business group plan. Group health coverage may help employers attract and retain employees while giving workers access to medical benefits.

Small business health insurance options vary based on company size, employee eligibility, contribution requirements, carrier availability, and state rules.

Common Health Insurance Plan Types

HMO Plans
Health Maintenance Organization plans usually require members to use in-network providers, except in emergencies.
Some HMO plans may require referrals for specialist care.

PPO Plans
Preferred Provider Organization plans may offer more flexibility to see out-of-network providers, but out-of-network care usually costs more.

EPO Plans
Exclusive Provider Organization plans generally require members to use in-network providers, except in emergencies.

POS Plans
Point of Service plans may combine features of HMO and PPO plans and may require referrals for some services.

High-Deductible Health Plans
Some plans have higher deductibles and may be paired with a Health Savings Account, if they meet federal HSA eligibility rules.

Key Terms to Understand

Before choosing a health insurance plan, review the premium, deductible, copayments, coinsurance, out-of-pocket maximum, provider network, and prescription drug formulary.
The lowest monthly premium is not always the lowest overall cost. A plan should be reviewed based on both premium and expected out-of-pocket costs.

Enrollment Timing

Health insurance enrollment is usually limited to specific enrollment periods unless you qualify for a special enrollment period.
A special enrollment period may be available after certain life events, such as losing other coverage, getting married, having a child, moving, or other qualifying changes.
Enrollment rules, deadlines, and eligibility requirements vary by plan type and state.

Choosing a Health Insurance Plan

When comparing health insurance options, consider monthly premium, deductible, copayments, coinsurance, out-of-pocket maximum, provider network, prescription drug coverage, expected medical needs, specialist access, hospital preferences, dependent coverage, and eligibility for subsidies or tax credits.

Other Health-Related Coverage

Health insurance may not cover every health-related expense. Depending on your needs, you may also want to review dental insurance, vision insurance, disability insurance, Medicare coverage, Medicare Supplement insurance, travel medical insurance, long-term care insurance, critical illness insurance, or accident coverage.

These products are separate from major medical health insurance and may have their own benefits, exclusions, and eligibility requirements.

Review Your Health Insurance Options

Orion Financial Services LLC can help individuals, families, and businesses review available health insurance options and understand key plan differences.
Before enrolling, review the plan’s benefits, exclusions, provider network, prescription coverage, cost-sharing rules, renewal terms, and enrollment requirements.

ACA and Connecticut Health Insurance Law Updates

The Affordable Care Act, often called the ACA, changed how many individual and small group health insurance plans are offered and regulated. ACA-compliant plans generally include protections related to essential health benefits, preventive care, pre-existing conditions, annual and lifetime dollar limits for essential health benefits, and access to coverage during open enrollment or a qualifying special enrollment period.

Connecticut also adopted state-level protections tied to the ACA. For certain individual and group health insurance policies delivered, issued, renewed, amended, or continued in Connecticut on or after January 1, 2019, Connecticut law requires coverage for essential health benefits. These benefits generally include categories such as emergency services, hospitalization, prescription drugs, maternity and newborn care, mental health and substance use disorder services, preventive and wellness services, pediatric services, and other required benefit categories.

Connecticut law also includes additional protections for women, children, and adolescents. These protections may include coverage for certain preventive services, contraception-related services, breastfeeding support, immunizations, and preventive care and screenings for individuals age 21 or younger, subject to the terms of the law and the health plan.

Connecticut residents may review individual and family health plan options through Access Health CT, Connecticut’s official health insurance marketplace. Access Health CT is also the place where eligible Connecticut residents may qualify for financial help, including Advance Premium Tax Credits, Cost-Sharing Reductions, HUSKY Health, or the Covered Connecticut Program.

Premium tax credits may reduce monthly premium costs for eligible consumers. Cost-sharing reductions may lower deductibles, copayments, and coinsurance for eligible consumers who enroll in qualifying plans. Eligibility depends on household income, family size, access to other coverage, tax filing status, residency, enrollment rules, and current federal and state requirements.

Health insurance laws, subsidy rules, plan availability, rates, and enrollment periods can change. Consumers should review current plan documents, marketplace information, and eligibility rules before enrolling in or renewing health coverage.

Important Disclosure

This information is general in nature and does not modify, expand, or guarantee coverage under any insurance policy or health plan. Health insurance coverage is subject to insurer approval, eligibility rules, enrollment periods, plan terms, conditions, exclusions, limitations, provider networks, and premium payment requirements.

Product availability, benefits, premiums, deductibles, copayments, coinsurance, provider networks, prescription coverage, and eligibility vary by insurer, plan, county, state, and enrollment period.

Orion Financial Services LLC does not provide tax, legal, medical, or financial advice. You should consult a qualified professional regarding your specific situation.