Some links in this post are affiliate links* This post is part of theSkimm’s “No Excuses” Campaign for Healthcare. All thoughts and opinions are my own.
Tackling something a little less glamour than cheap & easy at home spa hacks today… healthcare.
I’ve always struggled with understanding healthcare. Growing up, I was fortunate enough to go to a regular general doctor, dermatologist, optometrist, dentist, and eventually gynecologist. I lived in a bubble and didn’t understand why everyone didn’t get all their annual check-ups done.
My mom had a great health insurance plan through her company. She put money into a health savings account (HSA) and a flexible spending account (FSA). It appeared we never had to pay for anything during a doctors visit.
* Health savings account: an account that allows you to set aside roughly $1,000-5,000 (depending on your policy) towards health expenses tax free. Unlike a flexible spending account the funds roll over annually if you don’t use them.
In 2009 I lost my dad to cancer. In 2010 I read “Pretty Is What Changes” by Jessica Queller (writer for Gilmore Girls, Gossip Girl, One Tree Hill, and more!) where she shared her journey from discovering she had the breast cancer gene, to taking preventative measures. Ashkenazi Jews are more likely to have the BRCA gene. Even though I am not 100% Ashkenazi, after reading the book I vowed to take care of my health. Because things can happen at any age as I’d seen too many times.
Enter my 26th birthday when I was kicked off my mother’s health insurance, and we were estranged to boot. I didn’t have anyone to teach me the in’s and out’s of insurance. To make things even more interesting, I had just started my own business a month or so prior. The year was 2014, the same year that as the deadline for non-grandfathered health plans to transition into the Affordable Care Act standards. In other words: health insurance plans and doctors still weren’t totally sure everything was going to work.
My plan kicked into effect in July. I had already seen all of my annual doctors and only had one trip left to the dentist. I didn’t really see/feel the effects of the plan I chose.
Not understanding my plan, I thought this whole ObamaCare business was the ish. I had no idea why everyone was freaking out. Fast forward to 2015. Only a mere 6 months later it was time for me to re-enroll. I selected the same plan even though the monthly premiums having gone up a little.
* Monthly Premium: The amount you pay each month for your health insurance
Only this time, my dermatologist and gynecologist no longer accepted it and I had no idea. It said they did on the directory, so WTH was going on? Turns out, doctor’s can actually pull out of a plan after the new year starts. Meaning you can sign up for a plan at the beginning of open enrollment and have no idea who will actually accept that insurance.
2015 I decided to skip going to a gynecologist and got my birth control from my doctor.
2016 the same thing happened.
2017, the same thing almost happened.
Clearly, I was not understanding the marketplace as well as I thought. So at the end of 2016 I worked with an insurance broker. I shared my plans to possibly get pregnant the end of 2017, but still wanted to have a low premium since I wouldn’t actually have a baby this year. We chose a plan I thought was a good fit, only to find out that once again, none of my doctors were accepting it.
Don’t get me wrong, the last few years I tried to find a gynecologist that did accept my insurance plan, but it was hard to find one I trusted to get up in my hoo-ha. My gynecologist delivered me, I’ve know him, quite literally, my entire life. I trust him, I trust his staff, and I trust the other doctors in his practice. The one’s that served my insurance were in areas I didn’t feel comfortable or they had horrible reviews/ratings on multiple sites.
As someone who once prided herself on always taking care of her body, what the heck was going on with me?
I take pride in being able to teach myself anything, so why was this such a wall for me? Perhaps it’s the ever changing landscape of health insurance in our country. Maybe it’s how carefully you have to look at and consider all of the things.
As a former substance abuse and mental health counselor, I can tell you, those benefits are often horrible. It’s a broken system that I will not get into today. If you have a history of mental health or substance abuse, please read the next part of this post and your policy carefully and ask questions (also get responses in writing) for in-patient treatment about billing.
When we moved this year, two very beautiful things happened:
a) theSkimm shared with me their plan for their latest “No Excuses” Campaign. ICYMI, theSkimm is a media company for millennial women to receive news and information. Its a M-F newsletter that basically breaks down all the current event’s for you with sources to investigate further for yourself. If you’re a Chelsea Handler fan like myself (she’s actually an investor!) you may have heard her talking about making “No Excuses” for going out and voting during the election on her Netflix show. This “No Excuses” campaign is tackling all the nitty gritty and evolution of healthcare and challenging us all to take care of our bodies and make a doctors appoint this year (whether its a general practitioner, gynecologist, dentist, all of the above or something else).
b) I was fortunate to qualify for an new open enrollment period.
With the upcoming “No Excuses” campaign, and a new opportunity to pick the right plan for my current situation in life. I decided to take the time and really learn about health insurance in a way I never did before.
Understanding Healthcare Terms:
Essential health benefits: Certain services that insurance companies have to cover under Obamacare. These include things like maternity care and prescription drugs. Under the GOP plan, states could opt out of this requirement.
* Fun fact, while insurance companies have to put things like maternity care in their plan, they do not have to cover it fully. In fact, many of the plans “maternity care” I reviewed, left the primary burden on the patient… I’ll explain more about this as a running example under each term.
Deductible: The amount you have to pay toward medical costs before your health insurance starts picking up part of the bill. Every plan is different but generally, paying things like hospital bills and lab tests count toward your deductible. If you have a $3,000 deductible, that’s how much you’re on the hook for before your insurance plan says ‘ok we’ll help now.’
* Many “maternity plans” require you to pay your deductible in full before they start kicking in. and then…
Co-Insurance: You and your insurance company share the claims payment. Typically after you’ve paid your entire deductible.
* Many will only cover 50% of the co-insurance after your deductible! Many plans say something like “50% Co-insurance” next to a benefit (not just specific to maternity). That does NOT mean they are going to pay 50% of your deductible like I used to think… what that means (even though it’s often not specified) is you pay your entire deductible, and then they will start paying 50% of anything after that.
Out of pocket Maximum: This is the maximum amount you are responsible for out out of pocket. In other words if exceed your deductible, and still pay co-insurance payments, eventually you will get capped at this number. – Out of pocket maximums differ for dental plans* so make sure you read carefully because for adult plans, there often isn’t one.
* This is the number to pay attention to. This is where your purse strings can finally close. You won’t have to pay anything additional. When I used to teach life skills groups at local substance abuse treatment centers, I would recommend people look at the out of pocket maximum and make sure they have that and at least 3 months of rent/utilities in their emergency fund.
Specialist Co-Pays: the amount you will have to pay to visit a specialists office
* While going to a dermatologist and gynecologist annually always seemed like primary care to me, it turns out it’s not. They are actually specialists. Unless its a general practitioner or family doctor, it’s probably a specialist.
Prepare For Life Events With Questions:
Once I had a basic understanding of healthcare terms, I decided to call my gynecologist. I wanted to figure out which health insurance plan would be right for me given that we’ll start trying to have a baby (most likely) towards the end of this year. I found a few comparable plans, but wasn’t sure which factors to pay closest attention too. For instance, copays for ultrasounds, lab work for blood, prenatal and post natal office visits co-pays, etc. With the knowledge I would be able to select a new plan in the new year, and I have no intention of having a baby this year, these were the questions I asked:
– How many ultra sounds can I expect in the first and second trimester?
– How many lab and genetic tests will we have to go through? My husband and I are both ashkenazi Jews so we will have more testing than the average couple.
– Number of prenatal office visits by trimester?
– What does the average billing process look like?
– What is the general cost of childbirth for their patients?
Depending on your unique situation these questions may change, or you may be calling a different type of specialist. Just consider the different medical needs/visits you’ll have and try to get an estimate of where you would prefer to save on your co-pay (whether it’s on an office visit or testing, etc.).
The entire call mentioned above took less than 10 minutes. I repeatedly apologized for asking so many questions. To my surprise she was actually relieved to be on the phone with someone asking pro-active questions. Most calls were reactive to a bill they didn’t think they would be getting. So don’t hesitate to get organized before enrolling! Your wallet and your doctors staff will probably prefer it!
Now, what are you waiting for? Get out there and schedule a doctor’s appointment!
If you’re interest in learning more about healthcare terms, the history, and what the heck is happening with it all right now, check out theSkimm.