Millennials, This Is What You Need To Know About Healthcare

understanding health insurance, understanding healthcare, health insurance tips, #healthcare, #healthinsurance

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!

Take Action

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.


 

RELATED READS:

What Happens To Your Body When You Go Off Birth Control?

6 Months After Using Those Weird Period Underwear: THINX

Harmful Communication Habits To Drop Today

9 Fears About Pregnancy + Why It's Okay

110 thoughts on “Millennials, This Is What You Need To Know About Healthcare”

  1. Interesting read! In my country we have a totally different health care system, but I do read a lot about the system in the US. It’s on the news quite often, because it’s so different from ours! I have to admit, it’s really difficult to understand, so I usually have no idea what they’re talking about, haha. But I’m starting to get it now!

    1. What country are you in? It’s SO difficult to understand and changes so fast! Thats why understanding the terms help a lot! theSkimm *linked above* is doing a great job breaking the history and everything happening with the system down right now!

    2. In the Netherlands! Our health care system is fairly easy. Just make sure you have an insurance and everything else will (mostly) be taken care of! It’s so good that you’re helping people to understand… it’s a tough subject!

  2. Omg little did I know how much actually goes in to healthcare! Luckily, I still have a couple more years to be on my parent’s health insurance, but I’m def pinning this errrrwhere so I kinda have a clue when I’m a “grown up” hahaha

  3. Wow. Thank you so much for sharing. I’m a few months away from being kicked off my dad’s insurance (also estranged) and I’m pretty terrified. I’ve looked over my company’s plan, and it’s decent, but it nowhere covers the same amount that my dad’s plan covers (hello, $10 co-pays!). I will definitely be on the look out for deductibles and out-of-pocket maximums when I pick my plan.

    1. Yeah, we definitely get spoiled on our parents plans! haha Also, don’t be afraid to look into plans outside of your companies! Depending how much you make, you could qualify for a subsidy (as long at Trump doesn’t get rid of them) – which are decent plans in terms of cost savings if you don’t have a specific doctor you need to see!

  4. This is great information! Thanks for breaking it all down! Insurance can be so confusing, especially with all of the changes happening right now in health care. Every young millennial should read this post.

    1. Ugh I hear that! theSkimm (linked above) is doing a great job breaking down the current status and issues at hand on their site if you want to read more!

    2. Thank you! I’ll definitely be sure to read that as well. So many people are misinformed about health care so they definitely should be reading these!

  5. Shannon @ Lady's Little Loves

    I feel like this is the kind of thing that should be taught in high school! great read!

  6. WOW. This is something everyone should be reading. Thank you so much for this. I love how you made it more readable, and I feel connected to health care and want to learn more!

    Xo, Marissa

    1. Ahh SO happy to hear it! Thank you! If you want to learn more, definitely click over to theSkimm’s campaign (they also right very relatable) and have a ton of info about the history, current state, and more definitions!

  7. I’m totally going to bookmark this! I keep telling my mom that I literally have no idea how insurance works/what the terms even mean, so when I turn 26 and am kicked off their plan I’m going to be totally lost. This is so helpful – so thank you!

    Tori

    1. Yay! Girl I hear you! I had no idea for years! Then I thought I knew, but still didnt! Then worked with an insurance broker and felt like it was kind of a waste since I still didn’t know anything. But putting in the little time to learn these phrases and call my doctors made a world of difference!

  8. Health insurance is very confusing for sure! You break down a lot of the key points in this post. The plan that my job offered wasn’t a good one financially, so I decided to opt out of it for this year and stay on my dad’s plan for another year.

    xoxo A
    http://www.southernbelleintraining.com

  9. Thanks for sharing! I’m planning to move down to the USA from Canada and I’m trying to figure out how healthcare works! So this is super helpful!!

    Lauren

    1. So happy it was helpful! If you’re looking for more info click over to theSkimm’s campaign linked at the bottom of the post. They also write very relatable and have a ton of info about the history, current state, and more definitions!

  10. Girl. People that actually work for the insurance companies should read this lol. I called ours the other day to ask questions and I would have been better off talking to a wall! You are the bomb for taking on these topics and explaining them ?

    1. HAHA I KNOW! I swear I feel like I knew more than the insurance broker I worked with both before researching for this post and definitely after! And forget calling the insurance companies! They just direct you in circles! Honestly, I like going through the marketplace because I can see everything and read through all the plans brochures haha Let me know if you have any more questions and if you want more info click over to theSkimm’s campaign linked at the bottom of the post. They do a great job breaking down the history, current state, and more definitions!

  11. YAAAAAAAAAS GIRL SO GOOD. So dang thorough. I’m with on not trusting everyone with my hoo-ha too hahaha. I love that you break it down so easily. I know about HSA versus FSA from J’s job, and experienced dealing with it firsthand when I needed to grab a steroid eye drop that was $200 (!!!)…being able to use those on a whim when needed was CLUTCH.

    1. Totally! I dont have access to any of that anymore so it really forced me to learn a lot more about how it all works to figure out how to use it to work for me rather than against me!

  12. I am SO glad that you did a post explaining what healthcare is, it is so important understanding healthcare plans that are available and picking a plan that meets YOUR needs! A year after I started working in the “real world”, my mom lost her job and so I ended up having to go on health insurance through my work rather than staying on hers. Looking back, I’m glad that I was forced into getting my own insurance. I had to learn all of the different terminology and pick the best plan for me. Now I feel like I understand healthcare pretty well and can pick something that is best for me, in my stage of life.

    Thanks again for sharing this 🙂 so many people can benefit from reading this!

  13. This. IS. Amazing. Seriously, you made sense of the entire healthcare mess. I always feel so overwhelmed and exhausted when it comes time to re-enroll or when healthcare changes. I totally agree with Tilley, you explained this SO much better than the people who work at the insurance companies. Fantastic post!

  14. Rachel, thank you SO much for tackling a topic that’s not fun, but is literally of life-and-death importance for so many people, now more than ever. I also admire what the Skimm is doing so much–people talking about this issue in no-nonsense, personal yet educational terms is exactly what we all need right now. So many of us are in a position of being able to take our healthcare for granted… until we can’t anymore. Whether it’s turning 26, switching jobs, becoming self-employed or getting laid off, welcoming a new member to your family [which I may also do this year, btw! yay for us!! :D], this can really sneak up on you, and scrambling to figure it out is a nightmare. I hope this is a helpful resource to many, many people!

    1. YES dude your comment made my day!!! I’ll respond in-depth tonight 😉 My birthday’s on Friday! Hellooooo long-lost twin sister <3 Oh, forgot to say – turns out I'm like 20% Ashkenazi too, HAHAH!

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