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.


 

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

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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. Wow, this is so useful! I am definitely not very educated on healthcare and am glad to learn more.

  2. You deserve an award for this post! It’s so well put together and informative. I know jack about healthcare and much like you’ve previously done, I just select plans. Definitely bookmarking this to refer to when it’s re-enrollment time.

  3. You did an awesome job with this post, Rach! I’ve been sorting out my own healthcare since I was 18. I was luckily able to pay small out of pocket fees directly to my doctor’s office because it was actually cheaper to pay as an “uninsured” person than to pay the co-pay with the insurance I had. I’m very lucky to have very comprehensive and full coverage right now. When I was looking for a doctor’s office a few years back I spent several hours doing research to find the best doctor that suited my needs and future needs that worked with my insurance. They even have an in-house lab so you don’t have to go anywhere for blood work and it’s so convenient. I feel like I could go on and on about my experience, lol. But seriously great job with putting all of this information together!!

    1. Thank you! YUP! IT really is! I had that experience at my dermatologist when I went in with the wrong insurance! I was like “are you kidding me?!?”

  4. Jennifer Schmidt

    This is going to come in handy! This is going to come in handy. I have a chronic illness and have been starting to look into health care and a lot of what I need isn’t covered.

    1. Oh I know that struggle. My husband has a chronic illness too. For brevity I decided to not tackle that as well, but I know he has some special thing to get his medication covered for it, but its SO many hoops to jump through to just get his basic care.

  5. literally bookmarking this and coming back to reference it bc I suck at being adult and have 0 idea about any of the important things… bless you (ps I do believe a few current members of our administration would also benefit from taking a look at this as they don’t seem to have much idea how health care works either)

  6. Wow this was the most amazingly helpful post for so many! Insurance is way more confusing than it has to be and you broke it DOWN! Awesome job tackling such a hard topic!

  7. I live in Ontario and I’m honestly obsessed with going to the doctors! I go every chance I get, and then some. Mostly from paranoia. But I totally understand how frustrating health insurance can be, since I do have to have it for other things like dental and prescriptions. It’s worth the time to look into what yours offers and then to make sure you take advantage of that, for your health.

  8. This was seriously so helpful. I wish this had been around when I turned 26 to help me figure it all out. I was left trying to take the advice of my parents and in-laws while trying to make sense of what was best for me. I had to purchase my own health insurance when I worked for a non-profit but made too much money to qualify for any marketplace discounts even though I could barely afford my premiums! I felt poor just trying to get health care I knew I probably wouldn’t even use! I only had the choice of one provider and they didn’t cover any of my doctors. I’m in a weird situation where all my doctors are technically out of state. We live on the river between states and all our health care providers aren’t in town even though they’re 5 minutes from my house. I felt hopeless and like I was wasting tons of my hard earned money! Luckily I have health insurance through my new job and can see all my old doctors! Insurance was a HUGE stressor for me and this guide spills it all out clearly!

    1. Ugh thats the worst! I swear, if you can get the marketplace subsidized plans its not the pad, but then it’s such a jump! like if you make a hair too much your screwed. – and that sucks! happy this was super clear and that you’re in a better situation now!

  9. This is a great breakdown and should be required reading for every graduating high school and college senior! I had my baby last summer, and even with employer provided insurance it can be messy. I am actually still fighting with them over a charge for the birth. Sigh. Persistence pays off, and yes, asking questions is ALWAYS good!

  10. This is absolutely amazing. Insurance companies don’t even explain this that well haha. And I’m right at that age that I’m about to be kicked off my parents plan too so this is so so so handy!!!

  11. Honestly health insurance is SO confusing. Growing up I didn’t have great insurance so I wasn’t ever allowed to go to specialists (like a dermatologist or anything other than the general doctor or dentist, even so I feel fortunate because not everybody can even do that). Now that I am 25 and heading back to school I am trying to figure out what I want to do in terms of health insurance. What’s going on with health insurance in our country is SO confusing right now so I’m even more lost.

    1. Totally hear you! You should click through to theSkimm’s info (linked at bottom of the post) – they break it down for whats currently happening/what it all means really well!

  12. This is SO informative!!! It’s seriously not easy to deal with insurance companies – I’m not 26 yet so I still get to be on my parents plan, but I dread having to get my own haha! I love theSkimm too – I get the newsletters but I’m realizing I haven’t taken advantage of everything they have to offer, so cool! Love this!

  13. Brittany Daoud

    This is pretty great! I work in healthcare and I definitely think you did a great job at summarizing this information. Insurance is one of the most frustrating parts of healthcare. Patients don’t understand it, doctors don’t always understand it to the fullest, and insurance companies never want to provide you with the full picture. Thanks for sharing your knowledge!

  14. My goodness. I feel like I learned so much about you in this post and at the same time, you shared so much informative information. This. Is. Incredible. Seriously, girl. I’m 27, and I still know nothing about insurance. I’m lucky that on the cruise, all of my medical expenses are covered, so I don’t have to worry about it, but when I’m on vacation (ahem…like now), I don’t even know what to do! This post is crazy informative, and I’m #grateful.

  15. Elizabeth Johnson

    Healthcare coverage is so frustrating. And on top of that the expected cost of things, for example child birth, never gets communicated. I realize that with child birth many different scenarios can happen but they won’t honor a quoted price. Also, interesting fact about medical billing, if you ask them to run down the bill and are very persuasive I have heard of people getting a discount. I was on the phone with my hospital talking through a bill from Sweet Bow’s delivery and if I paid that particular bill on the phone they knocked 20% off. My husband and I have an HSA and it is fantastic! I love that it is pre-tax money and we use it to pay monthly on Sweet Bow’s hospital bills. I highly recommend it. Side note: I did learn that if you don’t have an HSA and you pay a certain amount on medical bills a year it can be a tax deduction! Thanks for explaining this. Health insurance is so complex for no reason.

    1. Yes! That’s true (discount) and that’s good to know about the tax deduction! thank you! – it really is and it doesnt help that a lot of medical providers dont understand it themselves!

    2. Elizabeth Johnson

      Exactly! I do not like calling our health insurance because everyone I talk to is just reading a script. I want a human being talking to me and helping me understand. I also don’t like that when you ask them “what does that mean?” They define whatever you are asking about with more words you don’t understand. It’s like they just want us to give up and stop asking.

  16. This is so helpful! I feel like I’m constantly looking up these terms online so its so helpful that they are all right here!
    Neelofar | The Loveliest Lily
    ww.theloveliestlily.com

  17. Hanna Doerbeck

    Okay this is the post I have been needing to read for years. Thank you for writing this! haha my world just changed lol!

  18. I feel like I should have known this a long time ago. Thank you for explaining this!!! <3

  19. Denay DeGuzman

    Hands down this is the best and most important post I’ve read all week. It’s vital that we as women understand our plans and take control of our health. This is a very strange time in our nation’s history. Not knowing what the future holds for health insurance is on everyone’s mind.

    1. Wow thank you!! And totally agree! IF you click over to theSkimm’s site they break down the current state and what’s happening right now really well!

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