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When you need to purchase health insurance on your own (especially for the first time), the process might seem daunting. The Pennsylvania Insurance Department offers a helpful guide to the different types of health insurance, when and where to purchase insurance, and what you need to know as you shop for a plan.

Getting Started

It all starts at Healthcare.gov, the hub created by the U.S. Department of Health & Human Services for people to purchase and manage their health insurance. When you navigate to the site, you might notice that with a few exceptions, you can only purchase or change insurance during “open enrollment,” a specific time frame that occurs once a year. Open enrollment typically stretches from October or November and ends in December or January. You can find the dates of the next open enrollment at Healthcare.gov.

What Health Insurance Can Cover

Any new plan you purchase covers some or all of the cost of the following basic items and services:

  • Hospitalization
  • Specific prescription drugs and contraceptives
  • Emergency services
  • Outpatient care (care outside of a hospital stay)
  • Preventive services such as immunizations, pap smears, mammograms, and blood pressure screenings
  • Mental health and substance use disorder services
  • Wellness services such as disease management
  • Care throughout pregnancy
  • Basic laboratory services
  • Pediatric services including dental and vision care
  • Rehabilitative and habilitative services and devices

Certain services require prior approval from your health plan before you get them.

Your Primary Care Provider

Some insurance plans require you to obtain a referral from your primary care physician to see a specialized doctor. Other plans allow you to see certain doctors, providers, or specialists at any time. The Pennsylvania Insurance Department’s guide explains the difference between the two plans and how you’ll know which one is right for you.

Choosing a Plan

There are three questions to ask that will help you narrow the search for the right plan:

  1. Do you need access to a specific doctor or other care provider?
  2. Do you need a specific medical service or prescription drug?
  3. What mix of costs and fees (such as monthly premiums, copays, out-of-pocket limits, and deductibles) work best for you?

The guide explains why it’s a good idea to answer these questions to help determine the best coverage to meet your needs. There’s also a handy checklist to help you review and prepare for your plan purchase.

It’s easy to put off or forget to buy insurance until you need it. Having an insurance plan can help you stay healthy and offer protection in case you need unexpected medical care.

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