Members often have questions about their health plan, from the definition of terms to how to best utilize their coverage. Our Term Talk series aims to answer commonly asked questions to help you better understand health insurance and empower you to make decisions about your coverage that best fits your needs.
A common dilemma: It’s open enrollment season and I am choosing my own health insurance plan through my employer. I’ve done this before, so I understand that there are different plan types, like HMO and PPO—but one thing I find confusing is that my retired parents have the option of Medicare and I do not. Could you explain what the different health insurance options are for people of different ages?
Different types of health insurance
Here’s a look at the different types of health insurance available in the United States, along with who is eligible:
Employer-sponsored: This type of health insurance is offered to eligible employees and their dependents (like spouses or children under 26 years old). With employer-sponsored health plans, the employer typically chooses several health plans that their employees can select from that include monthly premiums that are often split between you and your employer.
Individual and family plans: For individual and family health insurance, you enroll on your own and not through an employer. These plans, which are available to everyone, can be purchased through your state or federal marketplace, health insurance companies or brokers.
Medicare: Available to those who are 65 or older (and some under 65 with certain disabilities or medical conditions), Medicare is a federal health insurance program that is comprised of four parts (Parts A-D), which includes hospital insurance, medical insurance, drug coverage and supplemental insurance.
Medicaid: Medicaid is a joint federal and state program that helps cover medical expenses for certain people with limited income or resources. Medicaid can also include coverage for things like nursing home care and personal care services. Medicaid eligibility differs across each state. In some instances, you may be dually eligible for both Medicaid and Medicare. Learn more about Medicaid and your eligibility.
Specialty health insurance: It’s important to know that health insurance does not always cover oral and eye health care. In order to get insurance for routine dental care and routine vision care, like cleanings or eye exams, you may need to enroll in a separate dental or vision insurance plan. In 2024, Point32Health, the parent company of Harvard Pilgrim Health Care, launched dental and vision coverage to employers to prioritize oral and eye health and create easier access for members.
If you’re a member that has a question about your Harvard Pilgrim health plan, contact member services at (888)-333-4742 or by sending a secure email. And for benefit documents and other member resources, log in to the secure member account.
