How health insurance works

In the USA, most people get coverage through employers or the ACA marketplace. Government programs include Medicare for seniors and Medicaid for low-income families. In Canada, provincial plans cover medically necessary hospital and physician services; residents often add private insurance for prescriptions, dental, and vision.

Premiums, deductibles, and copays

Premiums are the monthly price you pay to maintain coverage. The deductible is what you pay before insurance starts sharing costs; copays/coinsurance are your share after the deductible. In marketplaces, metal tiers (Bronze, Silver, Gold, Platinum) balance premiums vs. out-of-pocket costs.

Regional considerations

U.S. networks (HMO, PPO, EPO) impact which doctors you can see. In Canada, coverage varies by province—verify waiting periods for newcomers and what’s included (e.g., prescription drugs for seniors or children).

How to qualify & enroll

1. Check open enrollment dates (or special enrollment after life events).
2. Estimate income accurately for potential subsidies (U.S.).
3. In Canada, register for your health card upon arrival and consider supplemental private plans.

Compare private plans

Look at provider networks, prescription formularies, annual out-of-pocket maximums, and telehealth benefits. Evaluate HSAs (U.S.) paired with high-deductible plans if you’re healthy and want tax advantages.

Money-saving tips

• Use in-network providers and ask for prior authorization when needed.
• Leverage wellness programs and preventive care.
• Ask pharmacies about generics and manufacturer coupons.

FAQ: Health insurance