Millions of us now have health insurance under
the Affordable Care Act, or what some people call Obamacare. But like many things in life, your health
insurance can often be confusing and complicated. Whether you've been insured for years or you're
new to the game, understanding your policy is important to your health…And your wallet. First things first, you have to pay your premium
every month or your insurance could get cancelled – kind of like your cable subscription.
You can also think of it like a shared health
care piggy bank — we all chip in each month, even if we're healthy, so the money is there
when we need it. If you get insurance at work, your employer
probably pays most of your premium and the rest comes out of your paycheck automatically. If you have Medicaid, you most likely don't
have to pay any premium at all — the federal government and your state take care of that. If you're insured through a new health insurance
marketplace, depending on your income, you may be eligible for a tax credit that pays
a portion of your premium.
Once you have that shiny new insurance card,
you'll want to try really hard to keep it in your wallet! To better your odds at staying healthy, be
sure to take advantage of the free preventive services that all new insurance plans provide. But of course…Stuff happens. And that's
when insurance really comes in handy. Now, having insurance helps a lot, but it
doesn't mean all your health care is going to be free.
There are lots of details about your insurance
plan that affect how much you pay when you get sick or injured. If you have Medicaid, a lot of these services
could very well be free. Otherwise, you'll likely have to pay something
when you go to the doctor or fill a prescription. This is called a copay when it's a specific
dollar amount — like $25 per visit…Or coinsurance if it's a percentage of the bill.
There's also the deductible — that's how
much comes out of your own pocket before your insurance starts paying. Depending on your plan, you might have a deductible
for all your care, or it might only apply to some types of care, like hospital stays
and prescriptions. So read your plan material, because it can
add up to thousands of dollars! Another important part of your plan is the
out of pocket maximum. This is the most you'll ever have to pay in any one year.
for the benefits your plan covers. Your insurer will pay 100% of anything beyond
the maximum for the rest of the year. It can be just as confusing dealing with prescriptions!
Your plan has a list of drugs it will pay for, called a formulary, but the prices vary. Check with your doctor or pharmacist, because
a generic drug might fix you up the same as a brand name drug, but the price difference
could be huge.
So, those are the costs typically involved,
but remember that they'll be affected by your insurance plan's provider network. This is a list of doctors and hospitals that
are connected to your plan. Insurance companies negotiate discounts with these providers. Stay in-network, and the discounts get passed
Go out of network, and you could end up paying
full price. And remember that out-of-pocket limit? It
won't work if you go out of network! In some plans — like HMOs or EPOs — your
insurance would pay nothing if you go out-of-network. In other plans — like PPOs — your insurance
will cover you no matter where you go, but you'll pay a lot more if you go out of network. Also, if you want to visit a specialist – like
an orthopedist – some plans require a referral from your primary care doctor.
Sound easy enough? Well, sometimes staying
in-network can be tricky! In a hospital, it's possible that your surgeon
could be in-network, while your anesthesiologist is not. If this happens to you, don't be afraid to negotiate with your provider
or file an appeal with your insurer. So as you can see, there's a lot to think
about when you choose an insurance plan each year. Some plans may have low premiums, but fewer
doctors or hospitals and high deductibles.
There are tradeoffs, and understanding and
choosing among plans isn't always easy. Remember, if you have questions call your
health plan and ask, or check with your hospital or doctor. If you still have questions, your state insurance
department or Consumer Assistance Program can help. With the Affordable Care Act, there's new
support for consumers, so take advantage of it! Having health insurance protection is a good
thing, especially when you know how it works.
We hope you're now better prepared for the next time you have to pull that insurance card out of your wallet..