290 yuan's medical insurance generally refers to urban and rural residents' medical insurance, while 390 yuan generally refers to employees' medical insurance. The differences are as follows:

1. Protection object: Medical insurance for urban and rural residents is mainly for urban and rural residents, and medical insurance for employees is mainly for on-the-job employees and freelancers.

2. Payment method and amount: the medical insurance payment standard for urban and rural residents is low, generally once a year, and the medical insurance payment standard for employees is high, generally paid monthly.

3. Reimbursement ratio and scope: The reimbursement ratio and scope of urban and rural residents' medical insurance is usually smaller than that of employees' medical insurance.