The ABC's of Health Insurance A Guide of Health Insurance Terms so that Families can choose the right health insurance policy

The ABC’s of Health Insurance

Disclosure: I would like to thank United Health Care for sponsoring today’s post. This post is for informational purposes only and you should contact a plan administrator if you have any detailed questions about choosing a heath care plan. 

The ABC's of Health Insurance A Guide of Health Insurance Terms so that Families can choose the right health insurance policyIf you don’t currently have a health insurance policy, now is the time to get signed up as soon as possible before open enrollment closes unless you have health insurance through your employer (they have their own set open enrollment dates and you would have to contact HR for those dates). However, if your employer doesn’t offer insurance then it is your responsibility to find a suitable health insurance plan for your family. Insurance plans are somewhat difficult to understand if you never had insurance. Since Obama care went into effect last year, there are a wide variety of options under the Affordable Care Act.

The Affordable Care Act aims to help more people get access to affordable health insurance. The Act also guarantees coverage for pre-existing health conditions, and financial assistance for those who qualify. This may include savings on your health insurance premiums via a tax credit or a government sponsored program, such as Medicaid, the Children’s Health Insurance Program (CHIP), or Medicare. Plus, this year starts the first year that you will be charged a penalty when you file your 2015 taxes if you or your family isn’t enrolled in an insurance plan.

A – Affordable Plans

Like I mentioned above, the Affordable Care Act is aiming to help people find affordable health insurance. If you already have a policy or need a policy, it is possible to save money on a new plan especially if you qualify for financial assistance. Many new applicants were able to save around $250 a month on a new insurance policy at United Healthcare. Here are some of factors that will qualify you for financial assistance:

  • The number of people in your household
  • Age of household members
  • Annual household income
  • Where you live

B – Benefits

Each plan has very specific benefits that it will pay for each claim. The plans can be somewhat complicated and it is important to ask questions before you purchase a policy. Depending on the plan that you choose, you should always look at the following things when researching an individual or family policy: see costs. If you are seeing a particular doctor or provider, you should make sure that they are covered under the plan that you are considering so that you are looking for a new provider.

C- Costs

When you are looking at choosing a health care plan, you need to factor in these costs in addition to your monthly premiums.

  • Co-pay – Amount of money you will pay for a doctor visit, specialist appointment, urgent care, and emergency room visits.
  • Deductible – The deductible is usually applied to services like labs, x-rays, MRI’s, inpatient care, maternity care, surgeries, ect depending on the policy. You will have to pay your deductible in full.
  • Co-Insurance – Co-insurance picks up when you have met your deductible. Then you are required to pay a percentage of the costs associated with items that fall under your deductible.
  • Max Out of Pocket – This is the maximum amount of money that you will be required to pay out of pocket. The max out of pocket costs include your deductible and co-insurance amounts. Once you reach the max out of pocket expenses, then generally anything after that the insurance covers in full.
  • Prescription Benefits – Make sure that your policy covers your prescription costs.

D – Deciding on Which Plan is Right for You and Your Family

It is very important to choose a plan that is right for both financial and your current medical needs. Picking the wrong plan could end up costing you a ton of money out of your pocket.  For someone who has a ton of medical problems and requires frequent visits to the doctor, it might be more beneficial for you to choose a low deductible plan even though the monthly premiums are a bit higher or find a plan that covers everything done in your doctor’s office is covered under your office visit co-pay. Before deciding, it is best to talk to a representative so that you can ask these questions before you purchase a plan. Remember that you are stuck with the plan you pick until the next open enrollment period.

If your family is generally healthy it might make more sense to choose a high deductible plan. The monthly premiums are cheaper and it will protect you in case of an emergency. If you do sign up for a high deductible plan, you should put money aside in a Health Savings Account (HSA) that you can use to pay for qualified medical expenses. This will allow you to set aside pretaxed dollars into a savings account. Just remember that the money must be used by the end of the year or else you lose it.

E- Extra Services and Savings

Most people don’t realize that most insurance companies offer extra savings programs as part of their insurance package. These extra savings include: access to a nurse 24 hours a day even weekends and holidays, discounts for health programs, access to preventative care and immunizations, eye care discounts, and more.

F – Finding Access to Doctors

Once you have a medical plan, you can easily search for providers in your area. For example, on United Health Care’s site, you can find their provider list here. It is important that you find an in-network doctor or facility so that you can lower your out of pocket costs. Choosing a provider out of network will result in higher out of pocket costs or they may not even be covered at all.

If it is an emergency situation and you have no control over who you see, always call your insurance company and let them know this so that they can try to work with the provider. Some doctors are willing to accept the negotiated rate or the insurance company will adjust the claim, it just depends on the circumstances and it is worth having them check into it for you.

G – Great Service and Reputation

When selecting health care for my own family, I would find a company who offers great customer service and has a reputable customer satisfaction ratings such as United Health Care.

H – Health

Your health matters and it is important to find a health policy that works for you and your health.

I – It Makes Sense to Protect your Health and Finances

Insurance protects you and your family from life’s unknown problems and accidents. Plus, it protects your family financially.

M- Maternity Care

Some policies have strict guidelines when it comes to maternity care. So if you are planning on starting a family, please speak to a representative before selecting an insurance plan.

O – Open Enrollment

Insurance companies only allow you to register for new policies during a certain time of year or make changes to your existing policy. It is a period of time during which individuals who are eligible to enroll in a Qualified Health Plan can enroll in a plan in the Marketplace. For coverage starting in 2015, the Open Enrollment Period is November 15, 2014–February 15, 2015. Individuals may also qualify for Special Enrollment Periods outside of Open Enrollment if they experience certain events. This doesn’t apply for Medicaid or CHIP, you can apply for these services anytime at your local Department of Health and Human Services.

P- Preventative Care

Most plans now cover preventative care services at no cost for you or a family member. You don’t have to worry about meeting your deductible to qualify for these services. Here is a list of a few things covered:

  • immunizations
  • pap smears
  • depression screenings
  • newborn hearing screenings
  • HIV screenings
  • diet counseling
  • cholesterol screening
  • and more

Q- Qualifying Event

This is a change in your life that can make you eligible for a Special Enrollment Period to enroll in health coverage. You normally have a certain time frame to find a new policy. Here are some examples of a qualifying life event:

  • moving to a new state
  • changes in your income
  • changes in family size (marriage, divorce, having a baby, or adopting a child)
  • gaining membership in a federally recognized tribe
  • status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder.

S- Special Enrollment Period

It is a special time outside of open enrollment which allows you and your family members the ability to sign up for health benefits. During the special enrollment period, you will have 60 days from the date of a qualifying status to apply for new health coverage. Employer based plans must offer at least 30 days after a qualifying event to make changes to your health coverage. Here is a list of special instances were you can apply for a special enrollment period for complex issues, you can find that list here.

X – Explanation of Benefits (EOB)

The EOB explains the benefits provided, the reimbursement amounts allowed, deductibles, coinsurance, or other adjustments taken, and the net amount paid.

Photo Credit: Free Digital Photo

What did you learn from this post today? Did you have a hard time choosing a health insurance plan for you or your family?

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6 responses to “The ABC’s of Health Insurance”

  1. Heather Avatar

    This is where I sometimes wish I lived in Canada, where healthcare is free. The cost of healthcare sometimes can be scary it. It looks like United HealthCare has some great options.

  2. Danette Lykins Avatar

    Great Resource! Thanks for sharing!

  3. Jessica Harlow Avatar

    This is such a helpful outline of some of the ins and outs of understanding health insurance! It can get confusing and overwhelming very quickly!

  4. Stefani Tolson Avatar

    Thanks for putting this together. Healthcare options can be so confusing.

  5. Stephanie Pass Avatar

    We are lucky to have United Healthcare through my husband’s work. It’s probably the best health insurance company I’ve ever had.

  6. […] Health insurance is constantly changing and things were supposed to improve once Obama Care was put in place. I remember when my husband’s company presented him with the health insurance plans, they didn’t explain coverage about hearing screenings, hearing aids, cochlear implants, and any other equipment that might be needed to maintain the equipment such as batteries, replacement items, ect. Unless you have experienced a hearing loss in your immediate family, you probably have no clue if your medical insurance company would even cover the costs. […]