HOW TO BE YOUR OWN
HEALTH CARE ADVOCATE
HEALTH LITERACY
The degree to which individuals have the capacity to
obtain, process, and understand basic health information and services needed to
make appropriate health decisions.
How many of you
know:
•
What a deductible is?
•
What an EOB is?
•
What preventative screenings should you as a
college student/young adult have? How often? What do they screen for?
•
Why do you have to have certain immunizations
when you are admitted to college?
Navigating Health
Insurance
Why do I need Health Insurance?
•
It is a way to affordably cover healthcare costs
•
It is a way to avoid extreme healthcare costs
•
It is a way to prepare for unexpected healthcare
costs
MUST-KNOW TERMS
In order to make an informed decision, it’s important to
understand what you are being offered in exchange for your monthly premium.
Before we examine your options in detail, let’s take a moment to get familiar
with the basic terminology all insurers use. **Insurance is a complicated and
often frustrating process. But, if you know the basics, it pays off.
Premium: What you pay, usually monthly, for your
insurance plan. This is a bill, and is unrelated to other out-of-pocket
expenses you are expected to pay.
Deductible: A fixed amount that you are expected
to pay for hospital or outpatient services. After you meet the deductible, your
insurance plan covers all or part of your expenses until year’s end.
Co-insurance: The percentage of costs you pay
after your deductible is met. Generally this is a percentage split by you and
your insurance provider; 80/20 splits are common and mean that you are
responsible for 20% of costs after the deductible.
Co-pay: Often confused with co-insurance, a co-pay
is a fixed amount that you agree to pay toward specified expenses. A common
example of a co-pay is the small flat fee you pay each time you visit a doctor.
Network: A group of providers that contractually
partner with your insurance carrier. Your insurance plan will incentivize you
to choose from this network by charging you less for treatment by these
providers.
Preventive care: Preventive care refers to the
treatment of illness before it starts. Vaccinations, certain screening exams
and annual checkups all fall under preventive care.
Pre-existing Condition: A medical illness or
injury that you have before you start a new health care plan may be considered
a “pre-existing condition.” Conditions like diabetes, COPD, cancer, and sleep
apnea, may be examples of pre-existing health conditions. They tend to be
chronic or long-term.
Group plan: In any insurance plan, all
policyholders form a group. Within this group there are likely to be a mix of
healthy individuals (most young adults) and those who require more care
(seniors or people with chronic illnesses). Insurance companies need to offset
the costs of participants who need a higher level of care, and group plans that
include healthy people allow them to mitigate this risk and keep overall costs
low.
How does it work?
•
You sign up for an agreement with an insurance
company
•
You pay a monthly premium which gives you
privileges of the company
•
Most insurances have a deductible which
is the amount you have to pay, above and beyond the premium, before your
benefits will pay
•
Some insurances have a co-pay which is a
small fee for a Dr. appointment (example: $25 co-pay for an office visit vs.
$200 without insurance)
•
Some insurances have a co-insurance which
is a percentage of the cost of services you have to pay (example: 15%/85%; you
have to pay your deductible before this goes into effect)
PROCESS EXAMPLE
•
You have signed up with Joe’s Health Insurance
Company.
•
You need to go to the Dr. for an earache.
•
You take your insurance card, look up the
website and see if you can find a Dr. in your network.
•
You find an in-network Dr. in your
town and you make an appointment.
•
When you check in for your appointment, you give
the receptionist your driver’s license, your insurance card and you fill out
the paperwork. You may have to pay your co-pay at that time.
•
You see the Dr. He gives you a prescription for
an antibiotic.
•
You take the prescription to the pharmacy,
present your insurance card and pay your co-pay for your
medication or the actual price whichever is less.
•
Meanwhile, the Dr.’s office files your claim
with your insurance company who processes it.
•
The insurance company will pay your Dr. for
their portion of the bill and will send you an EOB (explanation
of benefits). You will be billed if you owe anything.
Many insurance
companies completely cover preventive
care. (Note: some screenings are age based).
Reason: even if you are not having symptoms, many illnesses
can be detected early through routine exams and screenings. Earlier detection
means earlier treatment and a better health outcome.
•
Annual physical including screening tests
•
Immunizations and flu shots
•
Colonoscopies
•
Mammograms
•
Gynecological exam and Pap test
•
Prostate exam and screening
•
Dental exams and cleanings
•
Vision exam
Routine Health
Screening/Preventive Care (adults 18-39)
Medical
•
Check-up every 1-3 years: basic physical exam,
vital signs, lab work (cholesterol, glucose, etc.), immunizations (annual flu
shot)
•
Females: pap smear every 3 yrs; monthly self-
breast exam
•
Males: monthly self-testicular exam
•
Above may need to be more often depending on
history
Dental
•
Check up and cleaning 1-2 times/year
Vision
•
Check up every 2 years
How to Choose a
Healthcare Provider
•
Specialty
•
In your insurance network
•
Location
•
Reputation
•
Reviews
•
First impression
•
Physician/Doctor/MD/DO
•
Physician’s Assistant/PA
•
Nurse Practitioner/NP
Doc, it hurts when
I do this!
How to communicate with your Healthcare Provider:
•
Write it down: go prepared with a list of questions/concerns
•
Be honest: they can’t help you if they don’t
have all the information
•
If what they say is unclear, get clarification
•
Research and share your family medical history:
certain
illnesses have familial
tendencies
•
You have a right to a second opinion if you are uncomfortable
with the direction they are going
Questions: health@tfc.edu