To find out what type of health insurance you have, start with the card in your wallet or your insurer’s app. Most cards print the plan type on the front in letters like HMO, PPO, EPO, POS, or HDHP, along with the insurer’s name, your member ID, and often a group number. If the card shows a group number, you have an employer-sponsored plan. If it says Medicare or carries the Medicare logo, you’re in the federal program. Medicaid cards vary by state but usually say “Medicaid” or the state program’s name. Between the card, your most recent IRS Form 1095, and your policy documents, you can pin down exactly what you have.
Read the Card First
The card is the fastest answer. Look for three things: the insurer’s name, a plan type abbreviation, and whether there’s a group number. The plan type tells you how the coverage works. The group number tells you where it came from. A separate logo or program name (Medicare, your state Medicaid program, TRICARE) tells you if it’s government coverage rather than private.
Can’t find the card? If the coverage came through work, your HR or benefits office can confirm the insurer and plan type and send a replacement. For Medicare, call 1-800-MEDICARE. For Medicaid, contact your state agency. If you bought the plan yourself, log into the insurer’s website or call the number you were given at enrollment.
Match Your 1095 Tax Form to a Coverage Source
Every year, whoever provides your coverage sends an IRS form that identifies it. The letter after “1095” is the giveaway:1Internal Revenue Service. Questions and Answers About Health Care Information Forms for Individuals
- Form 1095-A comes from the Health Insurance Marketplace. If you received one, you have an ACA Marketplace plan bought through HealthCare.gov or a state exchange.
- Form 1095-B comes from insurance companies outside the Marketplace, from government programs like Medicare or CHIP, and from some employers with self-insured plans.
- Form 1095-C comes from large employers (generally those with 50 or more full-time employees) and confirms employer-sponsored coverage.
If you can’t put your hands on the form, check your prior-year tax records or your IRS online account. The form type alone narrows things down before you look at anything else.
What the Plan Type Letters Mean
Once the card gives you an abbreviation, you know how the plan handles networks, referrals, and out-of-network care:
- HMO (Health Maintenance Organization): You pick a primary care doctor who refers you to specialists. Out-of-network care generally isn’t covered except in emergencies. Lower premiums.
- PPO (Preferred Provider Organization): See any provider without a referral. In-network care costs less, but out-of-network is still partly covered.
- EPO (Exclusive Provider Organization): No referrals needed, but out-of-network care isn’t covered.
- POS (Point of Service): A hybrid. You pick a primary care doctor like an HMO but can go out-of-network at higher cost like a PPO.
- HDHP (High Deductible Health Plan): Higher deductible, lower premium. Only an HDHP lets you open a Health Savings Account.
If your card doesn’t print the plan type, the Summary of Benefits and Coverage will. Every insurer must give you an SBC on request, and it uses a standardized format that lists deductibles, copays, coinsurance, and the out-of-pocket maximum.2UnitedHealthcare. Summary of Benefits and Coverage (SBC) The Evidence of Coverage (sometimes called the full policy) goes deeper and explains network rules and prior authorization. A separate Glossary of Health Coverage Terms defines the jargon.3U.S. Department of Labor. SBC Uniform Glossary of Coverage and Medical Terms
If It Came Through Your Job
A group number on your card plus premium deductions on your pay stub means employer-sponsored coverage. Within that category, there’s one more distinction worth knowing. A fully insured plan is one where your employer contracts with an insurance company that pays claims and bears the financial risk, and it has to follow state insurance rules. A self-funded plan is one where the employer itself pays claims, often using an insurer only to handle paperwork, and it’s governed by federal ERISA law instead of state insurance rules. Your Summary Plan Description usually indicates which type you have; look for language about who bears the financial risk for claims. The distinction matters because appeal rights and some benefit requirements differ.
Enrollment happens during the employer’s annual open enrollment window. Outside that window, you can only enroll or change plans if you have a qualifying life event like marriage, a new child, or losing other coverage.
If You Bought It Yourself
Coverage you purchased on your own falls into two camps: Marketplace (on-exchange) or off-exchange. Both must follow ACA rules on pre-existing conditions and essential health benefits, but only Marketplace plans can carry premium tax credits.
Marketplace Plans
If you enrolled through HealthCare.gov or a state exchange, and especially if you received Form 1095-A, you have a Marketplace plan. These plans are grouped into four metal tiers that describe how costs are split between you and the insurer:4HealthCare.gov. Health Plan Categories: Bronze, Silver, Gold and Platinum
- Bronze: Plan pays about 60%, you pay 40%. Lowest premium, highest out-of-pocket.
- Silver: Plan pays about 70%. The only tier that qualifies for extra cost-sharing reductions if your household income is between 100% and 250% of the federal poverty level.
- Gold: Plan pays about 80%.
- Platinum: Plan pays about 90%. Highest premium, lowest out-of-pocket.
Your card or SBC usually names the metal tier. If not, log into your HealthCare.gov account or state exchange portal, where the plan name and tier appear on your coverage page.5HealthCare.gov. A Quick Guide to the Health Insurance Marketplace
Off-Exchange Plans
You can also buy directly from an insurer or through a broker. These are “off-exchange” plans. They follow the same ACA rules on essential benefits and pre-existing conditions, but they aren’t eligible for premium tax credits or cost-sharing reductions.
If you aren’t sure your off-exchange plan is ACA-compliant, check whether it covers the ten essential health benefit categories and whether it imposes annual or lifetime dollar caps on those benefits. If your plan was purchased before the ACA took effect in 2010 and has never been substantially changed, it may be a grandfathered plan, which is exempt from some ACA protections (including free preventive services). A grandfathered plan must disclose that status in its documents, using language stating the plan “believes it is a grandfathered health plan under the Patient Protection and Affordable Care Act.”6eCFR. 45 CFR 147.140 – Preservation of Right to Maintain Existing Coverage
If It’s a Government Program
Medicare
Medicare is federal insurance primarily for people 65 and older. You may qualify earlier if you’ve received Social Security disability benefits for 24 months, or immediately if you have ALS or end-stage renal disease.7Medicare. Get Started With Medicare Which part or parts you have matters:8Medicare.gov. Parts of Medicare
- Part A covers inpatient hospital care, skilled nursing stays, hospice, and some home health care. Most people pay no premium if they or a spouse paid Medicare taxes for at least 10 years.
- Part B covers doctor visits, outpatient care, preventive services, and durable medical equipment, with a monthly premium.
- Part D covers prescription drugs through plans run by private insurers.
- Part C (Medicare Advantage) is an alternative to Original Medicare offered by private insurers. It bundles Parts A and B (and usually D) and often adds dental or vision.
Your red, white, and blue Medicare card shows whether you have Part A, Part B, or both. If you’re in Medicare Advantage, you’ll also carry a separate card from the private insurer running the plan.
Medicaid and CHIP
Medicaid covers people with low incomes, with eligibility and benefits varying by state. CHIP covers children in families that earn too much for Medicaid but can’t afford private coverage.9Medicaid.gov. CHIP Eligibility and Enrollment The card typically says “Medicaid” or names the state program.
If you qualify for both Medicare and Medicaid, you may be enrolled in a Dual Eligible Special Needs Plan (D-SNP), which coordinates benefits between the two programs. Your plan documents or insurer can confirm whether that’s what you have.10Medicare.gov. Special Needs Plans (SNP)
If It’s Military or Veteran Coverage
Active-duty service members and their families usually have TRICARE, the Department of Defense’s health program. TRICARE has several plan types (Prime, Select, and others) depending on your status and location. Your military ID or TRICARE enrollment paperwork identifies which plan you’re in.
Veterans may be eligible for VA health care. After enrollment, the VA assigns you to one of eight priority groups based on service history, disability rating, income, and other factors. Veterans with service-connected disabilities rated at 50% or higher sit in the highest priority and generally pay nothing for VA care; lower priority groups may have copays. You can find your priority group by contacting the VA or checking your VA health benefits summary.11U.S. Department of Veterans Affairs. VA Priority Groups TRICARE and VA health care are separate systems with their own enrollment, networks, and benefits, though some veterans qualify for both.
If You’re on COBRA
COBRA isn’t a separate type of insurance. It’s a temporary extension of your former employer’s group plan after a qualifying event like job loss, reduced hours, divorce, or a spouse’s death. The coverage is identical to what you had, which is why your card may look unchanged. The difference is that you now pay the full premium (including the share the employer used to pay), plus up to a 2% administrative fee.
Federal COBRA applies to employers with 20 or more employees. You have 60 days from the election notice to enroll, and coverage generally lasts up to 18 months, or 36 months for certain events like divorce or a dependent aging out.12U.S. Department of Labor. FAQs on COBRA Continuation Health Coverage for Employers and Advisers If your former employer had fewer than 20 employees, federal COBRA doesn’t apply, but many states have “mini-COBRA” laws offering similar continuation rights with durations ranging from a few months to 36 months.
When What You Have Isn’t Actually Insurance
Two kinds of coverage look like health insurance and get sold alongside it, but they aren’t insurance and don’t carry the same protections. Mistaking one for a full plan can leave you exposed to major out-of-pocket costs.
Short-Term Limited-Duration Insurance
Short-term plans are meant to bridge gaps in coverage. They don’t have to follow ACA rules, so they can exclude pre-existing conditions, cap benefits, and skip essential health benefits like mental health or maternity care. Federal rules limit these plans to an initial term of no more than three months and a total coverage period, including renewals, of no more than four months.13Centers for Medicare and Medicaid Services. Short-Term, Limited-Duration Insurance and Independent, Noncoordinated Excepted Benefits Coverage Fact Sheet Signs you have one: a very simple application, a surprisingly low premium, and a term measured in months. The front page of the policy should be labeled as short-term limited-duration insurance.
Health Care Sharing Ministries
Health care sharing ministries (HCSMs) are faith-based groups where members contribute monthly amounts that get shared among members with medical needs. They are explicitly not insurance. State insurance commissioners don’t regulate them, they aren’t required to pay claims, and they don’t have to cover pre-existing conditions or cap your out-of-pocket costs. If your plan materials talk about shared beliefs or religious principles rather than guaranteed benefits, you likely have an HCSM.14National Association of Insurance Commissioners. What You Should Know About Health Care Sharing Ministries, Discount Plans, and Risk-Sharing Plans
Verify What You Have
Once you’ve identified the plan, confirm the details. Most insurers have online portals where you can review benefits, check whether a doctor is in-network, and download your policy documents. If you don’t have online access, call the member services number on the card.
After any medical visit, your insurer sends an Explanation of Benefits (EOB). It isn’t a bill. It shows what was billed, what the plan covered, and what you owe. Compare it against any bill the provider sends; discrepancies are common, and catching them early saves money and tells you quickly whether your plan is handling claims the way the policy describes.