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How Healthcare Works

How the healthcare system works, with a focus on health insurance.

When people have the information and support they need to confidently understand and use their healthcare benefits, they can make better decisions and improve their health outcomes. This can also help with healthcare cost management.

This series explores health insurance basics, from the industry’s history and the roles of different plan sponsors to the key terms and processes that shape the healthcare experience.

Health insurance does more than protect one person at a time. When more people have health coverage, the whole community benefits. Healthcare delivery groups can plan and invest for the long term, people can get care when they need it, and the community attracts high-quality care providers. This helps improve health for individuals, families, and communities.

Dr. Shantanu Agrawal

Elevance Health Chief Health Officer

The Evolution of Health Insurance milestone graphic showing 1920s Pay for service model, 1940s Employer sponsored insurance begins, 1965 Medicare & Medicaid launched, and 2010 Affordable Care Act expands access

Healthcare costs are consumers' biggest healthcare concern. (Elevance Health research, 2025)

58% of insured adults encountered issues using their insurance in the past year—such as denied claims, provider network problems, or pre‑authorizations. (Source)

Care providers use digital channels 94% of the time to find information. (Source)

~1 in 3 U.S. adults (32%) used AI (e.g., chatbots) for health information in the past year (Source)

Our industry must help members through the challenges presented by a shifting healthcare landscape. We’re embracing that responsibility with humility and intention, because we know trust is earned, and we believe a better approach to health and healthcare is not only possible — it’s essential.

Mark Kaye

Chief Financial Officer, Elevance Health President, Carelon

What Is the Purpose of Health Insurance?

Health insurance exists to help people get—and pay for—the care they need. It helps pay for covered medical services, from routine checkups and preventive screenings to emergency care, prescriptions, hospital stays, and ongoing treatment for serious or chronic conditions.

Types of Health Insurance in the U.S.

Health insurance coverage in the United States reflects more than a century of economic shifts, public policy decisions, and efforts to increase access and distribute financial risk. The types of health insurance coverage available today—employer-sponsored plans, individual policies, Medicare, and Medicaid—developed in response to market forces, government policies, and changing demographics while reinforcing a shared-risk arrangement.

Common Health Insurance Terms Everyone Should Know

Building a better understanding of health insurance includes becoming familiar with common terms. From premiums to provider networks, being familiar with these concepts makes it easier to anticipate costs, choose the right coverage, and access necessary services.

Maximizing Benefits: How Informed Decisions Shape Healthcare

Making the most of health insurance benefits means understanding processes and documents that apply to everyone and, at the same time, are specific to each individual. From open enrollment to explanations of benefits, knowing how these pieces fit together helps people make more informed healthcare decisions.

Ideas, Research, and Action