What is Health Insurance?
Some countries have free health insurance, but the United States does not. It can be difficult to learn and understand, but alas, that’s why I’m here! In most cases, you stay on your parent’s health plan until you’ve reached 26 years old. It also comes in handy when your employer includes health insurance in their benefits & packages. If you’re like me, and you went through life on your parent’s plan but need to switch off, here’s what you’ll need to know.
Health insurance is a type of insurance coverage that covers the expense of an individual’s medical bills. You’ll either be paying out-of-pocket costs and be reimbursed, or you make payments directly to your provider.
Being on your parent’s insurance plan is simple because you don’t need to know everything about it. But when the time comes to get off and get your own insurance, it’s normal to draw a blank… How do I get insurance? What insurance is best for me? Can I afford it?
Types of Health Insurance
HMO’s are one of the most popular health insurances you can purchase. You basically just select a primary care provider (PCP), and they will coordinate all your health services for you. They cover most types of preventive care, but your appointments are only covered if your PCP makes the referral. You’ll most likely have to pay copayment fees for non-preventive medical visits and you could have an annual deductible. HMO plans are best for individuals or families who see their primary doctor on regular basis.
PPO plans are nice because you don’t need a referral to use your insurance. You’re able to see any healthcare provider that is on your insurance network. You usually don’t need to choose a primary care physician or need referrals to see a specialist. You’re able to make appointments with whoever works in your network. You could have copayments for any non-preventive medical care or you could have an annual deductible. If you’re one to see a specialist regularly, this type of health insurance could be a good choice.
Looking for something in the middle? EPO plans are a combination of PPO and HMO. They have the flexibility of PPO but the cost-savings of an HMO plan. You don’t have to choose a primary care physician or need referrals to see a specialist. The only downside? It’s not as popular. You’ll have a limited network of doctors and hospitals who accept EPO plans and they don’t cover care outside your network unless a dire emergency. If you end up seeing a doctor who doesn’t accept your plan, you’d be expected to pay the full cost.
What If I’m On My Parent’s Plan?
If you’re under the age of 26 and your parents have health insurance, you’re likely on their plan. Your parents might have given you your insurance card, or they could be holding on to it, but regardless, your insurance card will have all the information you need. It usually says on the card if it’s a PPO, HMO or EPO plan, and it will have a phone number on the back for customer service. You can also go to your health insurance website to see the doctors and specialists who accept your insurance.
If you’re looking for mental health or substance abuse treatment, you can usually find on their website or by calling facilities if they accept your insurance or not. At New Start, we have a form you can fill out with the details from your insurance card and we can run your benefits right away. You can also take a picture of the front and back of your card and text us.
Behavioral Health and Mental Health are different when it comes to getting referrals from your doctor. In this case, you don’t need a referral for mental health (anxiety, depression, substance abuse, etc.). You can just call the number on the back of your card or look online for treatment facilities that accept in-network HMO plans.
Choosing the Right Health Plan
If you’re shopping around for health insurance, here are some tips.
-
Marketplace
If you’re through your employer, your work is essentially your marketplace. You won’t need to use the government insurance exchanges or other marketplaces.
If you choose not to use your employer’s insurance, it will likely cost more money as your employer usually pays a portion towards the employee’s premiums.
If your company doesn’t provide health insurance or you choose not to use it, your next step would be to shop on your state’s Affordable Care Act marketplace. You can also shop on the federal marketplace for a lower premium. You can go to HealthCare.gov and enter your zip code, and then you’ll be sent to your state’s exchange or the federal marketplace.
States in blue use a state-based marketplace. States in grey use a federal marketplace.
Additional options: purchasing health insurance through a private exchange or directly from an insurance website. *You won’t be eligible for premium subsidies (income-based discounts).
-
Choosing your health plan.
What’s the best plan for you? How do you decide? What do you choose? Here’s the breakdown.
If you’re not sure if you would prefer a primary doctor to coordinate your appointments and information, any network will be okay! It all depends on your preferences. PPO and HMO are the two most popular insurance plans. Some common plans within those networks are Blue Cross Blue Sheild, United Healthcare, Cigna, and Aetna. Visit HealthCare.gov to create your profile & sign up for insurance!
-
Compare!
Now that you have some idea of what you’re looking for, you can start comparing health plans. If you already have a primary doctor that you’d like to continue seeing, try finding plans that are in-network with your doctor. If you don’t have a primary, then it’s an open field and you can decide on your plan with what best fits your health needs.
It’s usually best to get a plan with a large network if you live in a more rural area. If you do, you’ll be able to find doctors and specialists closer to where you live.
-
Out-of-pocket costs.
This is an important factor because you don’t want to sign up for a plan with a crazy amount of out-of-pocket costs. You’ll be able to see how much you’ll have to pay out of pocket for services on any plan’s summary of benefits. Search for keywords such as deductible, copayments, or coinsurance.
The total amount you spent out of pocket in a year is limited, and it should show on your plan what the maximum is. The general rule of thumb is the lower your premium, the higher your out-of-pocket costs will be.
If you frequently visit the doctor for emergencies, to prescribe medication, plan on having children, having surgery, been diagnosed with a chronic disease, it’s best to choose a plan with a higher monthly premium.
Plans with higher out-of-pocket costs & lower monthly premiums are best if:
- You can’t financially afford the higher monthly premium
- You are in good health and only see the doctor for checkups
-
Researching Benefits.
So, you should have some idea of what you’re looking for. Maybe with a few options left to decide from, the final step is comparing the benefits of your chosen plans.
DON’T SKIP THIS STEP!
If you’re careless and sign up for a plan without comparing the benefits, you could miss out on a plan that fits better for you/family.
Asking questions is suggested in finding the right plan for you. Are you looking for a specific treatment? Do you have depression or anxiety and need specific medication? Are you looking to get into addiction treatment? By asking these important questions, you can narrow down the plan that best suits you.
Health insurance is so important. You never know when you’ll need it. Life is unpredictable and it’s better to be safe than sorry.
If you’re on your employer’s health plan, you have an easier decision to make. Employers usually pick a few different plans and you have the final choice in which one to take. But, if you aren’t on your parents and your employer doesn’t have health care in their benefits, this article will help you narrow down the options.
Find an insurance plan that best suits YOU. You’re the focus of it all and if there’s a specific treatment you need or want, go with the plan that suits that the best.
If You’re in Need of Addiction Treatment…
If you’re struggling with substance abuse and are willing to seek treatment, call us at 855-737-7363. We want to help you every step of the way. We accept clients all over the place and would love to admit you into our program.
Insurances we accept: Most PPO plans & Blue Cross Blue Sheild, United Healthcare, Cigna, and Aetna
