Foundations of Health Insurance: How Coverage Actually Works

Most people select a health insurance plan once a year during open enrollment — often guessing. The result is overpaying for coverage they never use, or getting hit with bills they assumed were covered. Understanding how health insurance is structured removes that guesswork and gives you a framework for every coverage decision you will ever make. By the end of this course you will be able to explain the core components of a health insurance plan, distinguish between HMOs, PPOs, EPOs, and HDHP structures, calculate your true out-of-pocket exposure under any plan, and evaluate whether a Health Savings Account makes sense for your situation. You will also understand how networks, formularies, and prior authorizations work in practice. What you will learn: - The difference between premiums, deductibles, copayments, and coinsurance — and how they interact - How HMO, PPO, EPO, and HDHP plan structures differ in cost and flexibility - What an out-of-pocket maximum is and why it is the most important number on a plan - How Health Savings Accounts and Flexible Spending Accounts work alongside HDHPs - How provider networks are built and what happens when you go out-of-network - The open enrollment timeline, qualifying life events, and Special Enrollment Periods - How to read an Explanation of Benefits and spot billing errors - Key terms in a Summary of Benefits and Coverage document The course is organized into four thematic sections: the anatomy of a health insurance contract, a side-by-side comparison of plan types, a deep dive into HSAs and FSAs, and a practical guide to navigating open enrollment. Each section includes annotated case examples, a glossary, and short self-assessment exercises to check comprehension before moving on. This course is designed for adults who are new to managing their own health insurance — recent graduates joining employer plans, self-employed individuals shopping the marketplace, or anyone who has always selected a plan without fully understanding it. No prior background in insurance or finance is required. This course is informational and educational; it does not substitute for advice from a licensed insurance broker or qualified health plan navigator in your jurisdiction.