Health Insurance Explained
This cartoon explains health insurance using fun, easy-to-understand scenarios. It breaks down important insurance concepts, such as premiums, deductibles and provider networks. The video explains how individuals purchase and obtain medical care and prescription drugs when enrolled in various types of health insurance, including HMOs and PPOs.
This is the third YouToons video written and produced by the Kaiser Family Foundation. The video is narrated by former U.S. Senate Majority Leader Bill Frist, a nationally-recognized surgeon and Foundation trustee.
What is Obama Care?
ObamaCare also known as Patient Protection Affordable Care Act is a law that was signed by President Barack Obama on March 23, 2010 and upheld by the Supreme Court on June 28, 2012. The goal of this law is to provide access to affordable and quality health insurance regardless of pre-existing conditions.
It also provides subsidies to families of certain income to help pay for the high cost of insurance (Ask how you may qualify for the federal subsidy).
Health Insurance Coverage
Your Health Insurance is a contract between you and the insurance company, which provides packaged medical benefits in exchange for a premium (payment often monthly, quarterly, or yearly). It is important to recognize that no insurance plan is the same, as they all have different coinsurance and deductibles.
Health Insurance provides basic benefits such as:
- Preventative services
- Prescription coverage
- Mental health services
- Emergency services and hospitalizations
- Maternity care
- Infant care and child care
- Dental and Vision (Optional)
Frequently Asked Questions
Don’t have health insurance coverage?
The enrollment period is here for a limited time of the year. Be sure to review your options before making the final choice on your health insurance plan. Our licensed agents are ready to help you navigate through finding the right plan for you.
Advanced Premium Tax Credits?
Need assistance paying your health insurance premium? APTC is awarded by the marketplace based on specific requirements under the patient protection affordable care act. Talk to one of our agents to see if you may be eligible for APTC to reduce your monthly premium cost. Families could save thousands on their health insurance premium.
Need to Renew?
Each year, your plan benefits may change. It's important to review the changes that may affect your plan to see if it's still the right fit for you.
Choosing the right Agent/Broker
An agent must be Licensed to provide health insurance advice in their respective state. Does that agent have an office and are they available year round or seasonal? Also, be sure to find an agent with experience and education as this can be critical if you may need help navigating in the world of health insurance post-enrollment.
Be sure to be familiar with the key terms of health insurance policies.
Premium: An amount you usually pay in a monthly bases to keep your policy active. It's important that you continue to pay your monthly premium to keep your policy active.
Deductible: An amount you are required to pay before the insurance beings covering their share of the cost for specified services. Some services may not require you to meet your deductible. Be sure to look at your benefits summary for more details.
Coinsurance: An amount you may be required to pay as your share of the cost of service or prescription drugs. Usually represented in a percentage (For Example 20%).
Out of Pocket Maximum per person: This is the total amount you spend on covered services within one year (not including premium payment)
Co-Pay: An Amount you may be required to pay as your share of the cost. This number is usually a fixed amount, not a percentage. For example, $30 copay for a doctor visit.
Cost-share: This describes the financial responsibly between you and the plan administrator. For example, If your Coinsurance is 20%, therefore, the cost sharing of the plan administrator is 80%
Evidence of Coverage: This document explains in detail your coverage rights and protections under the plan. Please read the documents carefully.
Identification Card (ID Card): This is the card that your insurance company sends you to verify that you’re a customer. It will usually contain the name of your PCP with their phone number. Contact your plan if you lose or do not get your ID Card.
Primary Care Provider (PCP): Your PCP is the organizer of your health care needs. He or she will help build a picture of our entire health. Your PCP is usually the go-to for your basics medical needs. Your PCP however, can also provide you a referral (when required) to see a specialist or obtain other related in and outpatient services.
In-Network Provider: A provider is a health care professional or health care facility contracted to be part of the plan's network. Be sure to verify if your providers are in the network of your plan. Not all plans have the same network. You may be required to pay extra or the full amount if you obtain out of network services.
Non-network Provider: A provider is a health care professional or health care facility NOT contracted to be part of the plan's network. You may be required to pay extra or the full amount if you obtain out of network services.
Prescription Drug List: Also known as a formulary, this list of prescription drugs, both generic and brand name, is used by healthcare providers to identify drugs that provide the best overall value. Be sure to review your list of medication and make sure they are covered by the proposed plan. You may be required to pay more or the full amount for prescriptions not included in your plans Drug formulary.
Referral: A referral is an approval from your PCP that allows you to see a specialist. Referrals are very important because you may be required to get one to see your specialist. Review your type of plan for example (HMO, PPO, or EPO) to see if you need a referral to see your specialist.
Service Area: Plan usually cover specified services within a geographical area (with certain exceptions like emergencies). Be sure to review your plans service area before making your final decision.
Summary of Benefits: This document provides a brief listing of your plans coverage and the cost-sharing you will be responsible for when you get the services.