Yes, it’s complicated—and yes, you need it. Blogger Kate Sitarz outlines why signing up for health insurance is an essential Grownup milestone.
When I got my first job, I took my employer’s health insurance plan. It seemed like the Grownup thing to do, though I knew little about its benefits.
A couple of employers and a move later, I got insurance via healthcare.gov. (My employer stopped offering insurance, so I needed new coverage.)
Then I got a call. Tests from an earlier doctor’s appointment (under my old plan) came back with “troubling” results.
“We need to do a follow-up,” my doctor told me.
However, the clinic didn’t accept my new insurance. I scrambled to get test results transferred—only to find out my new provider wanted to redo the test before taking next steps. I was relieved I hadn’t put off getting new insurance—otherwise I’d have been left wondering if I was dying a slow death.
As it turns out, I’m not alone. According to Beth Baker at the Boston Public Health Commission, city residents ages 25 to 34 are one of the highest percentages of uninsured Grownups. Many think insurance is too expensive or confusing, but that’s not entirely true. And it’s why demystifying health care is critical. (Source: “Who are the Remaining Uninsured?” Matthew Buettgens, The Urban Institute, July 2016.)
Do you need insurance?
Under the Affordable Care Act, Grownups can now stay on a parent’s health insurance plan until they turn 26. But after their 26th birthday, they no longer have insurance and need to get their own. For others, choosing a plan may happen sooner (e.g., with a new job).
Either way, check if you currently have insurance and, if you do, how long you’ll have it. In Baker’s experience, many Grownups only realize they’re uninsured when they go to the doctor’s office.
“Until you have a triggering event, there’s no reason to know you don’t have insurance,” she explains. Your parents may receive notices about your coverage ending, but if you’re working, they may assume you’re insured. Beyond the necessity of health care for emergencies, there are serious tax penalties to consider, too.
Get expert help—for free
Baker often encounters people who think they should figure the system out on their own and are embarrassed to ask for help. A health care professional in Michigan I interviewed could relate: “I work in this industry, took classes in grad school about insurance, and have a pretty good understanding of how it works and the terms they use, but I still found it overwhelming to sort through all the options.”
“And then you go to the site, and there are all these little barriers, like having to verify your identity,” Baker empathizes. These little annoyances add up, but that’s where folks like Baker can help.
Baker is called a “navigator,” and the Affordable Care Act provides funding for these unbiased certified experts. You can find navigators in your area that will look at your current doctors, prescriptions, and other health care needs to help you pick the right plan. Navigators can also help with basic health care literacy, like knowing what a deductible is, what your copay means, and the real-world financial implications of your plan.
Know when you can enroll
Each year, there’s open enrollment—a short period when you can sign up for health care. This way, insurance companies understand who they’re covering and how much they need to charge for premiums.
Can you skip the open enrollment period? No.
However, certain life events, such as unemployment, marriage, or moving qualify you to enroll outside the normal period.
Find out what you qualify for
“A lot of people between 25 to 34 qualify for Medicaid, and they don’t even realize it,” says Baker. If you have an internship or are at a low-paying job, you likely qualify for highly subsidized plans.
By going through the application process with a navigator, you can get peace of mind that you answered every question correctly. “The system is not smart,” admits Baker. “One of the questions is ‘Do you want help paying for health insurance?’ Everyone should say yes!” Otherwise, the system doesn’t screen for subsidies.
Daniel Held, a Missouri-based graphic designer, can attest to the importance of having a second set of eyes: His enrollment forms had a typo in his Social Security number. “I didn’t catch it until I had already purchased a plan,” he said. “The email healthcare.gov sent me after was really cryptic and didn’t tell me exactly what was wrong.” Luckily, after a few hours spent on the phone, his problem was fixed.
Expensive doesn’t mean better
Because navigators aren’t tied to a particular insurance agency, they have no incentive to sell you the most expensive plan. “Often the most expensive plan isn’t what’s best for you,” explains Baker.
Michael Lupacchino, a graduate student who recently moved from Connecticut to California, agrees. “Look past the price tag. I pay $36 extra a month, and that’s the difference between having a deductible and not having one,” he says, preferring to pay a little extra each month to not have to fork over $1,500 at once. “In Connecticut, I was on a gold plan. In California, I’m on silver, and the coverage is comparable.” Do your research: Often, gold, silver, and bronze classifications are irrelevant.
He also recommends knowing not what you want, but what you need: “I was looking to have my prescriptions covered and mental health coverage that wasn’t astronomical.” Depending on costs, he noted, it might be cheaper to pay for some services out of pocket versus having them covered.
Health care doesn’t like moving
Lupacchino first purchased health care in Connecticut while working remotely for a Massachusetts company. Because he declined his employer-offered care for Massachusetts, he didn’t receive a tax break despite a qualifying salary. When he moved to California, he was stuck on Connecticut insurance for a month as he navigated through his new state’s system.
Even if you’re just moving across town, start the process as soon as you know your plans to ensure you stay covered. “It’s crazy how much paperwork there is and how many hoops there are to jump through,” says the Michigan health care professional. “I still live in the same city, just four miles down the road, and I’ve already put hours into the process.”
Get ready to navigate
While healthcare.gov is the best place to start, it’s probably not where you’ll end up. Many states have their own marketplaces to shop for health care. Once you have your plan, you’ll probably also deal with your insurance agency.
With so many agencies involved, plan for sleuthing. “You go through the marketplace website for some things and your insurance website for others,” says the Michigan health care professional.
Lupacchino is similarly frustrated. “The folks working for the state are not insurance experts. They’re on a script and questions outside of that, they don’t know what to do.” When he moved, Lupacchino contacted his insurance agency to cancel his plan. “I paid them every month, they charged my credit card each month,” he rationalized. He was told his policy was canceled. “Then I came home at Thanksgiving and I have four letters from the state marketplace telling me I haven’t paid my premium,” he sighs. “They don’t talk to each other.”
Maximize your insurance benefits
“It’s worth revisiting your plan each year to make sure it’s the best plan,” Baker emphasizes. Certain things are covered each year (like a wellness visit) and as Lupacchino explained, his prescriptions are subsidized.
But beyond the basics, Baker notes your plan may reimburse for gym memberships, offer free helmets for kids, or free breast pumps to new moms. “Don’t be afraid to ask questions,” she continues. “I hear people say, ‘I didn’t know I could get help with this because I’m not poor.’ We help everyone.”
Check your bills
Once you’ve purchased your health care plan, you can still turn to navigators for help with things like understanding your bills. Baker often sees billing errors from providers and, occasionally, some things she dubs “shady.”
“During a wellness visit you may say ‘I have an earache,’ and that turns into six visits,” Baker says. “You just happened to mention ‘earache’ and then it gets coded as something else. We can help with the appeal process.”
Purchasing health care may still sting. As Held admits, “It stinks to pay anything because I don’t really use it. But I feel the need for a safety net.” The frustration lies more with insurance agencies, not the process of getting insured. For that, resources exist to make the process easier. “There’s no wrong door,” Baker stresses. “Just get the conversation started.”
“If I contract Zika, whatever epidemic, I have health insurance and that’s important,” half-jokes Lupacchino before adding, “there are a couple of things you need to do in life so you’re not up the creek without a paddle.”
That’s health insurance.
Kate Sitarz is a freelance writer living in Germany. Her work has been featured on Yahoo Travel!, The Huffington Post, and USAToday, among other outlets.
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