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Taking the Mystery Out of Health Insurance and Paying for Health Care Services

 

Most kids don’t think about how their health care services are paid for. As we get closer to graduating from high school and moving away from home, it is important to understand how health insurance works and how to manage our own health care. Health insurance can seem complicated and a mystery. Let’s break it down!

One of the most common ways to pay for health care services is through health insurance. Health insurance helps pay for services covered by your health insurance plan, like doctor’s fees, hospital bills, tests, and medicine.

  • Through an employer: You can get health insurance coverage through their job or a family member’s job. Usually employers and employees each pay part of the monthly fee.
  • Affordable Care Act: You can get coverage through the Federal Government’s Affordable Care Act which offers subsidies based on income that help cut health insurance costs for Americans who qualify. Individuals or families pay part of the monthly fee.
  • By an individual: Some people buy coverage on their own.
  • Medicaid: There is Medicaid, a joint federal and state program, which provides health coverage to some people with limited income and resources, and Medicare, the federal health insurance programfor people who are 65 or older and certain younger people with disabilities. 
  • Self-pay: If you don’t have insurance or don’t qualify for any of these programs, some clinics will offer self-pay options and even programs to reduce the cost of care.
  • “HMO” which stands for Health Maintenance Organization. They are a type of insurance provider that tend to have lower monthly costs and patients use the HMO’s network of doctors and hospitals.
  • “PPO” which stands for Preferred Provider Organization. They tend to have higher monthly costs in exchange for being able to use providers both in and out of network without a referral.
  • “Co-payment” or “co-pay” which is a fixed amount that an insured person pays, typically at the time of the service. The health insurance covers part of the costs for services, but the patient has to pay a part also and that is the copay. The amount of the co-pay is predetermined by your insurance plan and typically depends on the type of service you are receiving, and whether the provider is part of the health insurance network. Most insurance cards include the amount of your copays so you can know in advance what you will have to pay. Your card will also include a telephone number to call so you can verify coverage for a specific doctor or service before an appointment. Doing this can help you avoid and surprises!

As you head into adulthood, it’s important to know what type of coverage you have through your or a family member’s job, or how to get health coverage if those are not available. You can start by talking to your family members and employers. Health centers and your doctor’s office may also be able to help. You may also visit the website listed here.

You can also learn more about health insurance coverage at www.healthcare.gov/why-coverage-is-important.