Health insurance might be the last place you want to spend your money. After all, you are young and healthy. You rarely go to the doctor. Even so, getting health insurance is imperative. According to Health.CostHelper.com, a typical emergency room visit for a broken arm can cost more than $2,500. That cost escalates if you need surgery or follow up with an orthopedic specialist. Each year, 44.5 percent of the U.S. population go to the emergency room, according to the National Center for Health Statistics.
When you don’t have health insurance, you might consider delaying visits to the doctor. You might wait to see if whatever ails you goes away on its own. But that is risky and can result in even higher health care bills. Health insurance allows you to see a doctor when you need to, without worry about whether you can afford it.
Learn the terminology
Harry Ritter is the VP of Care Delivery of Oscar Health Insurance, a health insurance company that also recently opened a health center in New York, operating in parts of New York, California, and Texas.
In a recent phone interview with Health Central, Harry noted before looking for a health care plan, there are certain terms you should know:
Premium: the amount you pay monthly for your policy
Copay: a set amount of the medical charge you must pay out of pocket for a given appointment or treatment
Deductible: a set amount that you must pay before your insurance company begins to pay
Out-of-pocket maximum: The total out-of-pocket expenses, excluding premiums, that you will pay in one year. Once you reach your out of-pocket maximum, your health care will be covered in full by your insurance company
- Catastrophic plan: a health policy with a high deductible, designed to protect you in worst-case-scenario health emergencies. Premiums for these plans are lower, but out-of-pocket expenses are higher
Each policy has different amounts set for each of these. For example, the policy you choose might have a copayment of $40 for a doctor’s visit. That means each time you go to the doctor, you will need to pay $40, and your insurance will pay the balance. It is important to know the difference between these terms so you can compare your potential costs across several different policies to decide which is best for you.
Understand your unique health care needs
Ritter, listed on LinkedIn as both a doctor of medicine and law, suggests you think about your health care needs: How often do you go to the doctor? Do you have a health condition that requires you to see specialists? Are you on any ongoing prescription medications?
In addition, many health care policies have networks — or groups of medical providers — that are paid at a set level. When you see a doctor, go to a hospital or use a pharmacy outside of this network, your copayments and deductibles might be higher. If you feel most comfortable staying with your current doctors and medical providers, you will need to check to make sure they are covered in a policy’s network and, if not, decide if you are willing to pay more to keep the same doctors.
Do your research
How do you find out all this information? Before deciding on any plan, check to find out what the copayments, deductibles, and out-of-pocket maximums are. If you are shopping on a health care exchange, this information is available from the exchange. If you are working directly with a company, ask for the “explanation of benefits” (EOB) sheet. Once you narrow down plans based on your criteria (such as premium amount and copayment amount), use your typical medical care over the course of a year to determine how much you are likely to pay.
Ritter suggests you visit the insurance company website for a list of doctors and hospitals in its network. If you can’t find its directory or a provider search tool, call the company and talk with a representative. You can provide the name of your doctor and ask if he or she is included in the network for the policy you want. If you are on specific medications, ask how much these will cost under the plan.
You can also call your doctor’s office directly and ask the front desk if your insurance is taken by the practice.
The more information you can gather, the better you are able to make a decision. If you do your due diligence before purchasing a policy, you are less likely to be surprised with extra costs you thought would be covered if you have health care expenses.
Look for extras that can help keep you healthy and save you moneyHealth insurance plans sometimes have built-in features designed to keep you healthy or that can save you money.** For example, Ritter says Oscar Health Insurance offers:**
- Telemedicine, giving you free telephone access to a doctor 24 hours a day
- Rewards for meeting daily step goals
- Concierge teams to help you navigate the health care system
Some health care plans might also offer:
- Reimbursement for fitness programs
- Smoking cessation programs
Under the Affordable Care Act, there are a number of services that are available at no cost through insurance plans sold through the marketplace. These include:*
- Vaccinations, including an annual flu shot
- Annual physicals
- Preventive care
Taking advantage of these can help keep you healthy and, in turn, keep your healthcare costs down.
Ask for help
Deciding on the best health care plan can be confusing. If you have done your research and still aren’t sure what to do or you just want another opinion, talk to someone. Contact the customer service representatives for the company you are considering and ask questions. Contact the Affordable Care Act marketplace directly or look for a local agent who can walk you through the process and help you find the policy that will best meet your needs.
_*EDITOR'S NOTE: _ As the United States approaches the inauguration and early stages of a new presidential administration, reports have surfaced of partisan discussions to possibly revise or repeal certain policies under the Affordable Care Act. As of this writing, the ACA is still in place with no specific changes confirmed.
Eileen Bailey is a freelance health writer. She is the author of Idiot's Guide to Adult ADHD, Idiot's Guide to Cognitive Behavioral Therapy, Essential Guide to Overcoming Obsessive Love and Essential Guide to Asperger's Syndrome. She can be found on Twitter @eileenmbailey and on Facebook at eileenmbailey.