Who Does What in Health Care (English)

Who Does What in Health Care (English)


There are a lot of names and terms used
in health care, and many are alike. Knowing who does what makes it faster
– and easier – to find answers and get the most from your health care plan Let us introduce you. First, there are the marketplaces. They were made under the Affordable Care Act to help people get health care at a price they could pay. The marketplace is where you shop for, compare, and buy health care plans. Here in California, our marketplace is called
Covered California. Health care coverage and health insurance are
two ways of saying the same thing. We know that covered California helps you get it,
but who sells it? The health care coverage companies, also known as carriers or plans, sell it. They all try to offer the best health plan to one person or families, small businesses, or large companies. You’ve probably heard of these companies: Health Net; Kaiser Permanente; Aetna; Blue Cross and Blue Shield; Humana; and UnitedHealthcare. They’re all health insurance or health plan companies. You can buy health care coverage directly from a health care coverage company, or now you can buy a plan through covered California. No matter which way you buy, you can get the same plan with the same coverage. People who qualify for financial help have to buy health coverage through covered California to get it. Companies that sell through Covered
California are called qualified health plans, or QHPs. Now, that is a little confusing, because what you buy from a health care coverage company is
called a health plan. A health plan is a contract between you and the health care coverage company. You pay a monthly premium to have coverage, and the health care coverage company pays a large part of your health care costs. Most health plans have a name, but it’s not the same name as the health care coverage company. For example, your health care coverage company
might be Health Net of California, Inc., but the name of your health care plan
might be Community Care HMO. So what about the people in places that
offer health care services? There are doctors, specialists, labs, pharmacies, urgent care centers, hospitals, and others. You might hear this group being called
“providers” or a “provider network.” Thanks for watching. Now that you know the key health care
terms, check out these short videos to learn about how plans work, the costs of coverage, the differences between in and out of network and more.

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