Insurance 101

Understand Your Coverage

No jargon, no pressure. Explore how coverage really works — then let Fredrick match you to the right plan.

Where Coverage Comes From

Health insurance falls into two broad worlds. Toggle between them to see your options.

Employer-Sponsored

Group plans offered through a job. The employer typically pays a share of the monthly premium, making it the most common way Americans get covered.

Direct / Off-Exchange

Bought straight from an insurer or through a licensed broker like Fredrick — useful when you want hands-on guidance choosing a plan.

Short-Term

Temporary, limited coverage that bridges a gap — between jobs, after aging off a parent’s plan, or while waiting for open enrollment.

Know Your Network

HMO · PPO · EPO · POS

The plan “type” decides how you see doctors and what you pay. Tap one to explore.

PPO

Preferred Provider Organization

See any doctor without a referral, in or out of network. The most flexible option — and usually the most expensive.

Referral

Not needed

Out-of-Network

Covered (higher cost)

Relative Cost

$$$$

Flexibility

Best for: People who want maximum choice, specialists, or travel often.

Feature	HMO	PPO	EPO	POS
Primary care doctor	Required	Optional	Optional	Required
Referral needed	Required	Not needed	Not needed	Required
Out-of-network	Emergencies only	Covered (higher cost)	Not covered	Covered with referral
Cost level	$	$$$$	$$	$$$

The Terms, Decoded

Speak Insurance Fluently

The fixed amount you pay every month to keep your coverage active — whether or not you use any care.

What you pay out of pocket for covered care before your insurer starts sharing the cost.

A flat fee for a specific service, like $30 for an office visit or $15 for a prescription.

Your percentage share of a cost after you’ve met the deductible — for example, you pay 20% and the plan pays 80%.

The most you’ll pay in a plan year. Once you hit it, your insurer covers 100% of covered services.

The doctors, hospitals, and pharmacies contracted with your plan to provide care at negotiated rates.

The list of prescription drugs your plan covers, usually organized into cost tiers.

Approval your plan must grant before it will cover certain medications, tests, or procedures.

Common Questions

Still Wondering?

Once a year during Open Enrollment. Outside that window, a qualifying life event — losing coverage, moving, marriage, a new baby — opens a Special Enrollment Period.

It depends on your network. HMO and POS plans require a referral from your primary care doctor; PPO and EPO plans let you book specialists directly.

PPO and POS plans still share the cost (you just pay more). HMO and EPO plans generally cover out-of-network care only in a true emergency.

They’re advance tax credits based on your household size and estimated income. Many people qualify for meaningful monthly savings — Fredrick can check for you in minutes.

Medicare is federal coverage tied to age (65+) or disability. Medicaid is income-based and run jointly by your state and the federal government.

Ready to put this into practice?

Bring your questions. Fredrick will translate all of this into a plan that fits your life and budget.

Book a Free Consultation