Explained Health Insurance – The You Too Have It Covered
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00:00But like many things in life, your health insurance can often be confusing and complicated.
00:06Whether you've been insured for years or you're new to the game, understanding your
00:10policy is important to your health and your wallet.
00:15First things first, you have to pay your premium every month or your insurance could get canceled,
00:20kind of like your cable subscription.
00:23You can also think of it like a shared health care piggy bank.
00:27We all chip in each month, even if we're healthy, so the money is there when we need it.
00:32If you get insurance at work, your employer probably pays most of your premium and the
00:37rest comes out of your paycheck automatically.
00:40If you have Medicaid, you most likely don't have to pay any premium at all.
00:45The federal government and your state take care of that.
00:48If you're insured through a new health insurance marketplace, depending on your income, you
00:53may be eligible for a tax credit that pays a portion of your premium.
00:58Once you have that shiny new insurance card, you'll want to try really hard to keep it
01:03in your wallet.
01:04To better your odds at staying healthy, be sure to take advantage of the free preventive
01:09services that all new insurance plans provide.
01:15But of course, stuff happens and that's when insurance really comes in handy.
01:22Now, having insurance helps a lot, but it doesn't mean all your health care is going
01:27to be free.
01:28There are lots of details about your insurance plan that affect how much you pay when you
01:32get sick or injured.
01:35If you have Medicaid, a lot of these services could very well be free.
01:39Otherwise, you'll likely have to pay something when you go to the doctor or fill a prescription.
01:45This is called a copay when it's a specific dollar amount, like $25 per visit, or coinsurance
01:51if it's a percentage of the bill.
01:54There's also the deductible.
01:56That's how much comes out of your own pocket before your insurance starts paying.
02:01Depending on your plan, you might have a deductible for all your care, or it might only apply
02:05to some types of care, like hospital stays and prescriptions.
02:09So read your plan material, because it could add up to thousands of dollars.
02:16Another important part of your plan is the out-of-pocket maximum.
02:20This is the most you'll ever have to pay in any one year, at least for the benefits
02:24your plan covers.
02:25Your insurer will pay 100% of anything beyond the maximum for the rest of the year.
02:32It can be just as confusing dealing with prescriptions.
02:36Your plan has a list of drugs it will pay for, called a formulary, but the prices vary.
02:42Check with your doctor or pharmacist, because a generic drug might fix you up the same as
02:46a brand-name drug, but the price difference could be huge.
02:51So those are the costs typically involved, but remember that they'll be affected by your
02:56insurance plan's provider network.
02:59This is a list of doctors and hospitals that are connected to your plan.
03:04Insurance companies negotiate discounts with these providers.
03:07Stay in network, and the discounts get passed to you.
03:10Go out of network, and you could end up paying full price.
03:15And remember that out-of-pocket limit?
03:17It won't work if you go out of network.
03:20In some plans, like HMOs or EPOs, your insurance would pay nothing if you go out of network.
03:26In other plans, like PPOs, your insurance will cover you no matter where you go, but
03:31you'll pay a lot more if you go out of network.
03:35Also, if you want to visit a specialist, like an orthopedist, some plans require a referral
03:40from your primary care doctor.
03:43Sound easy enough?
03:44Well, sometimes staying in network can be tricky.
03:48In a hospital, it's possible that your surgeon could be in network, while your anesthesiologist
03:53is not.
03:54If this happens to you, don't be afraid to negotiate with your provider or file an appeal
03:59with your insurer.
04:01So as you can see, there's a lot to think about when you choose an insurance plan each
04:05year.
04:06Some plans may have low premiums, but fewer doctors or hospitals and high deductibles.
04:12There are tradeoffs, and understanding and choosing among plans isn't always easy.
04:17Remember, if you have questions, call your health plan and ask, or check with your hospital
04:22or doctor.
04:23If you still have questions, your state insurance department or consumer assistance program
04:27can help.
04:29With the Affordable Care Act, there's new support for consumers, so take advantage of
04:33it.
04:34Having health insurance protection is a good thing, especially when you know how it works.
04:39We hope you're now better prepared for the next time you have to pull that insurance
04:43card out of your wallet.
04:45Stay safe, America.