Guide
Getting the Most from Your Health Insurance
This guide helps people understand their health insurance, ask informed questions, maximize their benefits, and navigate coverage decisions with confidence. It also provides practical strategies for resolving coverage problems and making the most of available benefits.
Primary audience: Patients and families navigating the U.S. healthcare system and using health insurance benefits.
Additional audiences: Healthcare professionals, patient advocates, social workers, case managers, care coordinators, and caregivers who support patients in understanding and navigating health insurance.
Topics Covered
- How to understand your health insurance coverage before receiving care.
- How to navigate coverage denials, prior authorization requirements, and the appeals process.
- Informed questions to ask about insurance decisions and coverage policies.
- Ways to maximize available health plan benefits and compare healthcare costs before receiving care.
- How to keep organized records and stay engaged until concerns are resolved.
Why This Resource Matters
Many people have health insurance but struggle to understand their coverage, resolve insurance problems, or maximize the benefits available through their health plan. This guide provides practical steps and questions to help people make informed coverage decisions and navigate insurance-related challenges with greater confidence.
What's Inside
- Understanding Your Coverage
- Coverage Denials, Prior Authorization, Appeals Process, Medical Necessity
- Health Insurance Documentation and Questions to Ask Your Insurance Company
- Maximizing Health Plan Benefits and Comparing Healthcare Costs
- Open Enrollment and Complex Care Support
- Consumer Assistance Resources
Download the Resource
Formatted PDF
Includes graphics and layout.
Download PDF of Getting the Most from Your Health Insurance (PDF, opens in a new tab)Additional Resources from Other Organizations
- HealthCare.gov – Understand Health Insurance (opens in a new tab)
Explains key health insurance concepts—including premiums, deductibles, copayments, coinsurance, provider networks, and out-of-pocket costs—to help people compare plans and better understand their coverage before receiving care.
- CMS – No Surprises Act: Know Your Rights (opens in a new tab)
Explains federal protections against surprise medical bills, outlines patients' rights under the No Surprises Act, and provides guidance on what to do if they receive an unexpected medical bill or a bill that is higher than expected.
- Patient Advocate Foundation – Insurance & Access Resources (opens in a new tab)
Provides practical tools and educational resources to help people navigate insurance denials, appeals, prior authorization, financial assistance, and other common coverage challenges.
Continue Learning
Keep exploring with another resource from the Center for Person-Centered Care.
Guide
When Health Insurance Says No Or Makes You Wait
Learn what to ask, what to document, and what steps may help when health insurance delays or denies care or coverage.
Explore Resource – When Health Insurance Says No Or Makes You WaitMake the most of your health insurance coverage by accessing care that reflects your health needs, priorities, and everyday life.
The Health Guides, Visual Snapshots, and Clinical Practice Resources were reviewed by a physician for clinical accuracy and by other reviewers to improve readability, clarity, and ease of understanding.
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