Understanding your health care | Our Corner

Thanks to the Affordable Care Act, everyone has to have health insurance or there will be a penalty. In 2014, I qualified for free health insurance so I didn’t have to pick a plan; it was done for me, thanks to the nice lady on the other end of the phone. It was a different story in 2015.

Last February my three friends and I were buzzing around the kitchen trying to make dinner. We are all tired from a day of sledding at Mount Baker and I was still dizzy and on cloud 9 from seeing Britney Spears in concert the night before. My childhood dream of seeing Britney Spears had finally come true thanks to my amazing friends. In the midst of all of the excitement, I had that tiny feeling that I was forgetting something. You know the feeling, the one that just won’t go away until you remember what you were missing. And I finally remembered… I had one hour to sign up for health insurance.

Thanks to the Affordable Care Act, everyone has to have health insurance or there will be a penalty. In 2014, I qualified for free health insurance so I didn’t have to pick a plan; it was done for me, thanks to the nice lady on the other end of the phone. It was a different story in 2015 . I actually had to pick a plan with zero knowledge on how health insurance works. I looked at the clock and I had 30 minutes to figure it out. It was not an easy task. I had to look up what some terms meant and I was even more confused by the end of it all. With 10 minutes to go, I picked the cheapest plan and called it a day.

While I chose a plan in time to not get penalized, I still did not understand exactly what I was paying for. The deadline for coverage starting on Jan. 1, 2016, was Dec. 23 but coverage starting in February or later isn’t until the end of the month, or later, depending on your coverage. I got a lot of calls and emails weeks before the Dec. 23 deadline (even though my coverage doesn’t need to start until March). But, it was a nice reminder that I have a month or so to pick a good plan. I decided to really look into figuring out how all of this health insurance stuff works instead of blindly picking a plan again. I wanted to completely understand what every term meant. After looking through dozens of webpages and documents, here are a few terms and tips you should know to help you in your search.

DEDUCTIBLE: The amount you are responsible for paying for medical expenses each year, before your health insurance takes over and pays the rest. For example, if your deductible is $1,000 and you have a medical bill of $6,000, you pay $1,000 and your health insurance pays the rest.

CO-INSURANCE: The amount you have to pay for medical services after you’ve satisfied any co-payment or deductible required by your health insurance plan. Co-insurance is typically expressed as a percentage of the charge. For example, if your bill is $10,000, co-insurance is 20 percent and deductible is $1,000; you will have to pay the $1,000 deductible then $2,000 for the co-insurance (20 percent of $10,000), so all together you’re paying $3,000 for a $10,000 bill.

COPAYMENT: Usually a fixed dollar amount such as $15, every time you visit the doctor or fill a prescription. Not all plans have copayments and they do not usually accumulate toward the deductible.

OUT-OF-POCKET MAXIMUM: The most you will have to pay for covered medical expenses in a plan year through deductible and coinsurance before your insurance plan begins to pay 100 percent of covered medical expenses.

The next thing you need to know before choosing a plan, is deciding on your needs. You may need a lot of medical services or you may not. This might be one of the most important pieces to the health insurance puzzle. You shouldn’t have to pay for services you don’t think you will use. Yes, accidents happen unexpectedly and that’s the reason for deductibles and out-of-pocket maximums, but will you really need to pay for an insurance that provides acupuncture? Or chiropractor visits? Or massages? If you answered yes to any of these, then go for the plan that covers those things. If you answered no, you shouldn’t have to pay for a plan that provides them. Most insurance websites ask you questions about your health and habits to help you choose what coverage you need. While it may seem like a tedious task, it is important that you do. Based off your answers, you will get the right coverage. Some provide discounts based on your answers. Such as, if you’re a nonsmoker, you could get a small discount. The more medical services you will need, the more expensive your monthly payment will be. You also have to decide how much out-of-pocket you can pay if a big medical bill came along. If you can pay more, your monthly bill will be cheaper. If you could not pay much, your bill will be higher every month. The insurance companies are trying to cover their bases. If you can pay a higher deductible and out-of-pocket expenses, they know during a big emergency they won’t have to pay as much because you can. So, your monthly bill will be cheaper to make up for that.

There have been a lot of disagreements over the years about our health care system and some people don’t think it’s fair to force health insurance upon us. But the whole goal of everyone having health insurance is prevention. I’ve read countless stories about people going to the doctor because of the insurance they have and they were able to catch an illness early enough to where it wasn’t life threatening. Some will also argue that it is cheaper to pay the penalty at the end of the year than for health insurance. While that may be completely accurate (I pay more than three times as much for health insurance in one year than the penalty would be), I would need to never get sick or need medical services. Once I would need those services without insurance, I will have wished I had insurance because of how expensive health services are without insurance. Even a normal medical visit can be expensive.

I have been very lucky in the sense that I do not need medical services and it is frustrating sometimes to see money taken out of my account every month for something I am not using. But it is nice knowing I have insurance to fall back on if I ever do need more medical services than just a check-up. In the long run, I would save money if I needed emergency services, and potentially my life.

 

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