Health Insurance Terms You Need to Know (in the U.S.)

Let’s start with a breathing exercise. Okay? In through the nose... and out through the mouth.... Today we’re getting into a calm frame of mind, because we’re gonna talk about health insurance. [♪♩INTRO] Health insurance can be a super confusing and frustrating thing to deal with. But it’s a huge part of adulting! Since we don’t have a crystal ball for how the future of American health care will turn out, we won’t be talking today about what kind of public or private health care plan options might be available to you. Instead, this will be a primer on the very basics of health insurance for an individual, regardless of where your insurance is coming from. Now, the next time you’re choosing a plan or someone asks you how it works, it won’t all seem like some alien language. First up, let’s talk about your insurance policy that you’ll buy from your health insurance company. This is the plan that says how much you’re paying and what kind of services the insurance

company will pay for, including routine checkups and emergency care. Insurance policies usually last for one year and you’ll typically sign up for a new one around December or January, unless your employment or life changes. Many health insurance policies exclude dental and vision coverage, so you’ll need to buy an additional policy to cover those things if you have, uh, eyes and teeth. [laughter, because what else?] When choosing your insurance policy, it’s really important to understand how much your premium will be. The premium is how much you pay each month for the service, just like Netflix. If you get your health insurance through your company, they might automatically deduct the payments from your paycheck. If you signed up for a plan through the Affordable Care Act or a private insurer, you’re in charge of remembering to pay the premium each month. How much your premium costs will be largely related to your deductible. The deductible is how much you have to pay for your health care before the insurance company will start reimbursing claims, the bill for the service.

Usually the doctor’s office or hospital that you went to will send the claim, aka the bill, directly to your insurance company. If your deductible is high, like, say, six thousand dollars, that means you will have to pay out of pocket for six thousand dollars’ worth of services before your insurance kicks in and starts reimbursing claims. But! Even if you haven’t met your deductible, most insurance plans do cover almost all of the costs of routine preventative care, like getting a yearly checkup or a gynecological exam. Pretty much every plan defines routine care differently, so it’s a good thing to read up on when picking a plan. They make it really confusing. The type of health insurance company you’re buying a plan from might make a difference when it comes to choosing which doctors you can see. If you’ve ever heard of HMOs, AKA health maintenance organizations, they only cover procedures performed by certain professionals in a network. You’ll want to make sure that the doctor you go to is in network for your HMO. But wait!

If your health insurance comes through a PPO, or a preferred provider organization, that means they’ll cover your doctor visit at different rates depending if that doctor is in-network or not. Whether you get health insurance through an HMO or a PPO, make sure you know whether your doctor is in network and prepare to shell out accordingly. If it’s hard to figure out by googling, you can usually just call a doctor’s office and ask them if they can work with your insurance plan. After you sign up for a health care plan, the company might require that you choose a primary care provider. Lucky you, we made a whole entire video for this already! When you go to a clinic or hospital for any kind of care, you may need to break out your wallet for a copayment, which is a fixed amount expected to be paid to the doctor’s office when the service is rendered. So let’s say that you’ve spent enough on health care this year that you meet the cutoff for your deductible. Awesome. Insurance will cover everything now, right? Well, not quite. You might still need to pay coinsurance on any additional doctor’s visits for that

year. Coinsurance is usually a percentage of the bill, not a fixed amount. Health insurance companies sometimes describe it as “your share of the costs of a health service,” because yay, don’t we all love sharing. So, we could go on about how healthcare works for a ridiculously long time. But ultimately, the most important thing to understand about your health insurance plan is—as much as you probably don't want to—pay attention. Health insurance is weird and complicated and the companies themselves do not always get everything right, and mistakes can happen when it comes to billing for claims. Read your plan when you sign up, read the bills when they come in and make sure that your insurer is covering everything they are supposed to pay for. If you go to the doctor and then suddenly get a bill for a service you thought was covered, do your research and be prepared to fight for what you deserve. The best way to resolve a conflict over an insurance bill is usually to call up the company and ask for a real live human to help you solve the problem. Politeness goes a long way when dealing with insurance companies.

And remember, breathe deeply. [breathing deeply] You got this. Thank you for joining us! If you want to learn more about adulting with Rachel and me, you can subscribe to How to Adult at youtube.com/learnhowtoadult And if you liked this episode and want to support this channel, consider becoming a patreon patron at patreon.com/howtoadult —guided meditation with Hank. I'm going to get right down in the microphone... That'd be a good... P4A perk. Yeah. Guided sleep meditation with Hank. [off-screen] ASMR. [off-screen] Hank's AMR... AMR. Hank's arm. [laughter] My arm talks to you about sleep. It'd be really hard to send that to you in the mail. [laughter] You can't have my arm! Anyway, let's do this thing. Before my legs fall off. Eventually this is not comfortable anymore. [off-screen] Yeah, you can de-pretzel. De-pretzel. Deep pretzel.

Deep pretzel: IBM's new supercomputer. Yeah. [laughter] [off-screen] It's got a built-in food court. Read your—read your plan when you sign up. You messed me up. Our eyes met! [laughter] Read your plan! Noooooo! It's too long!