HEALTH AND HEALTH CARE: HEALTH INSURANCE

Health insurance is a way to pay for health care. If you get sick or injured, you may need to go to the doctor or the hospital, and you may need to get prescription drugs. All of these things can be extremely expensive. Health insurance protects you from paying the full costs of these medical services. Health insurance also helps you pay for many other medical expenses such as routine check-ups, prenatal care if you’re pregnant, prescription medicines, and even some mental health services. Depending on the type of health insurance plan you get, you may have to pay a monthly fee, called a premium, each month. In return, your health insurance will pay part of your medical costs.

WHY DO I NEED HEALTH INSURANCE?

For one thing, it’s now the law. The new health reform law, the Affordable Care Act (ACA), requires that everyone in the United States have health insurance. This is for your benefit and protection.

Aside from being required by law, health insurance protects you from paying the full amount of unplanned medical bills that can sometimes end up being tens of thousands of dollars. Anyone of any age could end up with unexpected medical bills.

For example…

If you break your leg, you might have to go to the emergency room. At the ER you might have to get X-rays, a cast, and prescription pain medication. You might also need surgery. If you do not have health insurance, a broken leg could easily cost you over $10,000. If you do have health insurance, your broken leg would probably only cost around $500 to $800. While this may seem expensive, health insurance would still save you over $9,000.

Source: Aflac Insurance Company

HOW DO I GET HEALTH INSURANCE?

There are a few different ways to get health insurance.

From your parents

If your parents have health insurance that includes you, you can continue to be on their plan until you turn 26. If your parents do not have insurance that includes you, or they are on something called Medicaid, then you will need to find your own insurance when you turn 18.

For more information on being on your parents’ plan, visit:

FAQ on Young Adults and the Affordable Care Act(U.S. Dept. of Labor)

State-by-State Breakdown of Young Adult Coverage

From your spouse

If you are married and your husband or wife has health insurance, you may be eligible to be included in their health insurance plan.

From a job

Many full-time jobs and some part-time jobs offer health insurance. Here is a list of companies, like Starbucks and Home Depot, that offer health insurance to their part-time workers. To find out about your health insurance options at your job, it’s usually best speak to someone in the Human Resources (HR) Department.

From the Health Insurance Marketplace

As part of the Affordable Care Act, the government recently set up the Health Insurance Marketplace. The Marketplace is a website where you can shop for health insurance. The monthly cost of your plan will depend on different factors such as your age and where you live. The website where you enroll depends on the state that you live in. Check out Healthcare.gov for “Individuals and Families,” and select your state to see how you can sign up.

From the Government

Medicaid: If your household makes under a certain amount of money each year, you may qualify for free or low-cost health insurance called Medicaid. Medicaid programs are different for each state. Check out Healthcare.gov’s webpage on Medicaid, and select your state to see if you qualify.

Medicare: Medicare is typically only for people over 65, but if you are disabled and unable to work you may qualify for Medicare.

HOW DOES HEALTH INSURANCE WORK?

Once you’ve signed up for your health insurance plan, you’ll receive an insurance ID card in the mail. You’ll need to bring this with you every time you go to a health care appointment. Make sure you know if this card is good for vision and dental benefits, too; often, these have separate insurance plans you can sign up for.

Some doctors’ offices will check your insurance before they let you make an appointment to make sure your insurance will pay for you to see that doctor. But some offices won’t do this, and if you see a doctor who isn’t covered, you may be responsible for the full cost of the appointment. This can end up being hundreds of dollars for the visit itself and any tests or procedures they do (i.e., blood tests, etc.). It’s always a good idea to check with your insurance company before your appointment to make sure your doctor is part of your covered network.

On the day of your appointment, you’ll need to pay your copay. This is different depending on your insurance, but typically is anywhere from $10 - $50 per appointment. Some doctors’ offices take credit or debit cards, but some might only take checks or cash. Check with them when you call to make the appointment about what kind of payment they accept.

After your appointment, the doctor’s office will send your insurance company a summary of what they did, including your visit with the doctor and any medical procedures or tests they did. The insurance company will check to make sure that all of those things were covered by your plan and then they will mail or email you an Explanation of Benefits, or EOB. This will tell you what the cost of your health care was and how much was covered by your plan. If everything was covered, this is just like an “FYI” and you won’t have to pay anything more than the copay you already paid at your visit. If some things weren’t covered, you may get an additional bill from your doctor’s office asking you to pay the difference. If you feel you shouldn’t have to pay this amount for some reason, most insurance companies let you submit an appeal asking them to cover these costs.

WHAT’S DIFFERENCE BETWEEN THE MOST COMMON TYPES OF HEALTH INSURANCE PLANS?

Below are the different options you might have from your employer or from the Health Insurance Marketplace under the Affordable Care Act.

HMO: Stands for “Health Maintenance Organization.” Usually less expensive cost per month, but also has a more limited network of doctors, hospitals, and labs you can visit. You’ll need a referral from your Primary Care Physician to see a specialist.

PPO: Stands for “Preferred Provider Organization.” Usually slightly more expensive cost per month, but gives more flexibility and allows you to see providers that aren’t in your network. With this type of plan, you don’t need a referral to see a specialist.

HDHP: Stands for “High-Deductible Health Plan.” These plans usually have a very low cost each month, but they have a high deductible. This means that if you get sick or injured, you will be responsible for a very high portion of the cost of your care before the insurance plan will start to pay.

Catastrophic Health Insurance Plan: This is like a “safety net” coverage in case you have an accident or get seriously ill. It doesn’t cover things like prescription drugs or shots.

Visit this page to read more about the differences among these types of plans.

CAN I KEEP SEEING THE SAME DOCTORS I HAVE NOW IF I GET NEW HEALTH INSURANCE?

This will depend on which kind of insurance plan you get. Typically, each doctor will be part of several different health insurance plans. This increases the chances that your new plan will let you continue seeing that same doctor. But sometimes certain health insurance plans have smaller networks, and your doctor may not be part of it. You can usually check the insurance company’s website to search for a doctor. You can also call them to check. If your doctor isn’t a part of your new plan, the company can also help you find a new doctor.

IS THERE ANYTHING I SHOULD KNOW ABOUT HEALTH INSURANCE IF I AM HIV-POSITIVE?

If you have HIV, now because of the Affordable Care Act, you CANNOT be denied health insurance. Click here to read about how the Affordable Care Act applies to people with HIV.

If HIV has caused you to become disabled and you are unable to work, check out this website to read more and see if you qualify for Medicare.

For more information about the insurance options listed above and how they affect people with HIV, click here.