Author Topic: Health Insurance  (Read 1915 times)

T-Rex

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  • Thirtysomething woman, military vet
Health Insurance
« on: June 18, 2014, 06:41:25 AM »
I have been on autopilot for a while, since I have Tricare and know to go to military hospitals/clinics.

Would anyone care to explain to me how health care for Americans works now, and the most up to date Mustachian best practice in a way a 8 year old could understand?

brewer12345

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Re: Health Insurance
« Reply #1 on: June 18, 2014, 07:52:39 AM »
If your employer provides coverage you pick the most cost effective plan and maximize use of in-network services (i.e. stuff that the insurer has in its pocket and already has contracts with).  Most of the less expensive plans have higher deductibles, so hopefully you will not use much in the way of healthcare services.

If your employer does not cover you or you don't have an employer, you buy an Obamacare policy most likely through the healthcare exchanges.  The exchanges were a bit technically challenged the first year, but pretty much everyone who wanted a policy through them eventually got one.  If your income is blow certain thresholds (94k for a family of 4) you get help paying for your policy.  Prices vary on location and type of plan, but you cannot be rejected, uprated due to health issues or have carve-outs or exclusions on your policy based on pre-existing conditions.  Networks vary a lot by area and plan.  I have excellent coverage through Kaiser, but others have had some challenges.

rubybeth

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Re: Health Insurance
« Reply #2 on: June 18, 2014, 07:58:38 AM »
Health care seems to work pretty much the same as ever. Do you mean how health insurance works? Or both?

Basically, most people still get health insurance through their employers. But if you want to buy your own coverage for whatever reason, you can't be denied because of pre-existing medical conditions and the application forms are pretty much just name/age/payment type like buying anything else (no more 20 page long medical questionnaires to determine what price you should pay). It depends which state you live in to determine your options for buying coverage. I'm in Minnesota, so I can use websites like e-healthinsurance.com, my state's insurance exchange website (MNsure), an insurance broker, or even go direct to the source (like Medica insurance) to buy coverage. Coverage options include the type of insurance that involves co-pays (this has a name but I can't think of it right now--these are sometimes very expensive but they cover everything, so can be referred to as the 'Cadillac plans' sometimes in the media) or a high deductible health plan (HDHP), which means you pay up to a certain dollar amount before insurance kicks in anything (my deductible is $2,750 for the year, so I pay the first $2,750 of all my health care costs, and then insurance would pay anything above that). I use funds in an HSA (health savings account) to pay for the deductible costs (when I get a bill from a doctor, I pay using the debit card connected to my HSA account).

As for care, most medical providers (hospitals & doctors) in my area take all the major insurance providers in my state, so I don't have to think about this much. I just go to my doctor for a check-up once a year or if I get really sick, and insurance pays whatever they're going to pay, and then I pay my portion (with the ACA now, though, my annual check-up and tests are 100% covered, no co-pay). Same deal at the pharmacy, except now birth control is covered 100% so no cost to me anymore.