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How Health Insurance Works
Health insurance offers a number of benefits. It covers crucial services, it’s less expensive than paying on your own for care and it provides financial protection. But it often requires help to successfully understand and navigate.
Things to Know About Health Insurance
- Types of plans. The two main types of health insurance are private and public. Private health insurance includes plans you get through an employer or the marketplace. Public health insurance is provided through the government.
- Private Plans:
- HMO (health maintenance organization) is a plan where you can only see doctors and use hospitals within a set network. You must choose a primary care physician (PCP) and will need a referral to see a specialist.
- PPO (preferred provider organizations) is a plan where you can see specialists without a referral from a PCP.
- POS (point of service) is a plan that combines aspects of HMOs and PPOs, with a network of approved doctors and hospitals.
- Public / Government Programs:
- Medi-Cal is California’s Medicaid program. The state and the federal government jointly fund it. It provides free or low-cost care to children and adults with limited incomes. For more information, call 800-541-5555 or visit medi-cal.ca.gov.
- Medicare is a federal program that covers people 65 and older, as well as some people with certain diseases or disabilities. Medicare now authorizes coverage for gender affirming care. For more information, call 800-MEDICARE (800-633-4227) or visit medicare.gov.
- Tricare is an insurance program for dependents of people in the U.S. military. For more information, visit https://www.tricare.mil.
- Private Plans:
- Network. This determines what list of doctors you are able to see for covered services. This can vary from plan to plan. If you want to see a doctor who is outside of your network, you may have to pay part or all of the cost out of pocket, or in some cases you may be able to get an out-of-network approval.
- Out-of-Pocket Expenses. For many people, health insurance pays a portion of their health care costs but not all of it. These costs are known as “out-of-pocket” expenses.
- This is an amount that you are expected to pay out of pocket each year before your insurance begins to pay for covered services.
- This is an amount that you are expected to pay with each service (doctor's visit, lab fee, x-ray), regardless of the deductible.
- Learn more about health insurance deductibles, copays and co-insurance. Watch video.
- Transgender Health Provisions. If you already have health insurance coverage, most information you need can be obtained from the plan website, your employer's HR department, or the phone number listed on your card. For information about transgender health provisions in the Affordable Care Act, visit the Department of Health and Human Services website.
UCLA Health Insurance Information
- UCLA Health accepts many types of health insurance. These plans include:
- Government health insurance programs (Medicare and Medi-Cal)
- Various Medicare Advantage, HMO, POS and PPO plans
- Learn more about the health insurance we accept. You can also check which plans our hospitals and doctors accept by calling the UCLA Health referral line at (800) UCLA-MD1 (310-825-2631), speak with your benefits coordinator at work (if applicable), or consult your health plan’s provider directory.
- Health Insurance and Patient Billing at UCLA Health
- See our FAQs.