0:02 howdy and thanks for learning about
0:04 health insurance with me Aaron boster
0:06 health insurance in the United States
0:09 can be downright overwhelming and yet
0:10 it's critical that you understand at
0:12 least the basics so that you can make
0:15 the best choices for you and your family
0:17 in this video I'm going to try to decode
0:19 health care and health insurance for you
0:22 going over the basics of how it works
0:24 sharing with you important terms to
0:26 understand and importantly sharing tips
0:28 to help you navigate the system don't
0:32 turn away because all that starts right [Music]
0:39 now
0:42 he so what is health insurance health
0:44 insurance is essentially a contract
0:47 between you and the insurance company
0:49 you pay a premium and an exchange the
0:51 insurance company helps you cover
0:54 medical expenses from routine checkups
0:57 to unexpected emergencies you can
0:59 conceptualize health insurance as a
1:01 safety for your health helping you
1:04 manage the cost of your medical care
1:05 let's break down some essential terms to
1:08 help navigating health insurance a bit
1:11 easier number one what is a premium a
1:13 premium is the amount that you pay
1:15 typically monthly to maintain your
1:19 health insurance number two deductible
1:21 this is the amount that you need to pay
1:23 out of your pocket before your insurance
1:25 starts to cover certain agreed upon
1:28 Services number three co-payment or
1:30 co-pay this is a fix fixed amount that
1:33 you pay for a particular service like a
1:36 doctor's visit number four Co insurance
1:38 this is the percentage of cost that
1:39 you're going to be responsible for
1:42 paying after you've met your deductible
1:45 number five outof pocket maximum this is
1:46 the absolute most that you're going to
1:48 pay in a given year before your
1:51 insurance picks up 100% of eligible
1:55 costs and number six a network this is a
1:58 group of Doctors Hospitals and other
2:00 providers that you're insurance plan has
2:02 contracted with to provide you with Care
2:05 at a reduced rate health insurance
2:07 typically include the following
2:10 components number one preventative care
2:13 many plans cover preventative Services
2:16 things like receiving vaccines screening
2:19 tests annual checkups with your doctor
2:21 and they're often offered at no cost to
2:24 you number two in network versus out of
2:27 network using in Network Services
2:30 usually costs less because the insurance
2:32 company has contracted with those in
2:35 Network Services to reduce the cost out
2:37 of network services are often times
2:39 either not available to you or you have
2:42 to pay more money to have access to them
2:44 plan types the first one we'll talk
2:46 about is called an HMO or a health
2:49 maintenance organization these require
2:51 you to use in Network Services almost
2:54 exclusively and they require you to
2:56 receive a referral from your primary
2:59 care in order to see a specialist next
3:01 we'll talk about a po or a preferred
3:04 provider organization these plans often
3:06 are more flexible in which providers
3:08 you're allowed to see and they don't
3:10 typically require referrals to see a
3:14 subsp specialist and last hdhp which
3:17 stands for a high deductible health plan
3:19 these plans typically have a lower
3:20 premium that you pay each month but a
3:23 higher deductible to access services and
3:25 they're often times paired with what's
3:28 called a health savings account or HSA
3:31 this is where you put pre tax money into
3:33 essentially a credit card if you will
3:34 and then you use it when you tap
3:36 Healthcare resources When selecting a
3:38 plan here are factors that you need to
3:41 consider number one what is the monthly
3:43 premium in other words can you afford
3:45 the monthly cost to maintain that
3:49 insurance product number two what is the
3:51 out-of-pocket cost and what are the
3:54 deductible costs so how much are you
3:55 going to need to pay before that
3:58 insurance kicks in to cover costs number
4:01 three coverages needs what does the plan
4:03 actually cover does it pay for the
4:05 medicines does it pay for doctor's
4:07 visits and does it pay for ongoing
4:10 treatments that you need number four
4:12 what is the network are your preferred
4:15 providers in that Network and available
4:18 for you to see and lastly additional
4:21 benefits some plant offer perks such as
4:23 allowing tele medicine services and
4:26 wellness programs so where can you
4:27 obtain health insurance in the United
4:30 States there's typically three different
4:34 sources either employer sponsored plans
4:37 private plans or government plans let's
4:39 talk about all three starting with
4:42 employer sponsored plans so most people
4:44 in the United States who are working
4:46 obtain insurance through their job
4:49 oftentimes sharing costs between the
4:53 employer and you if you are unemployed
4:54 or if your employer doesn't offer
4:57 coverage then you can often times
4:59 purchase a private insurance plan
5:02 through the health insurance Marketplace
5:05 or directly from an insurer number three
5:07 there are government plans these include
5:10 things like Medicare and Medicaid two
5:13 government run health insurance programs
5:15 within the United States and they serve
5:17 very different populations and they have
5:19 different purposes we'll start by
5:21 talking about Medicare Medicare is
5:23 primarily available for individuals over
5:27 the age of 65 or younger individuals
5:29 with certain disabilities and chronic
5:31 conditions things like endstage renal
5:33 disease Medicare is divided into four
5:37 parts Part A covers hospital stays
5:39 skilled nursing facilities and some Home
5:42 Health Care Medicare Part B covers
5:44 Outpatient Care things like doctor's
5:47 visits and then preventative therapies
5:49 part C is called Medicare Advantage this
5:52 is an optional plan which is offered by
5:55 private insurance it often times bundles
5:57 part A and Part B and then can include
6:00 extra benefits Medicare Part D B is what
6:03 covers prescription medications funding
6:05 for Medicare is provided through federal
6:07 payroll taxes premiums are paid by
6:10 enroles and federal government revenue
6:11 it's a federal program so it's
6:13 standardized across the entire United
6:16 States now let's talk about Medicaid
6:18 Medicaid is designed for lowincome
6:21 families and individuals including
6:23 children pregnant women and people with
6:26 disabilities eligibility varies from one
6:29 state to the next Medicaid is intended
6:30 to provide what's called comprehensive
6:33 coverage including doctor's visits
6:36 Hospital space long-term care and more
6:39 now some states have expanded medicaid
6:41 under the Affordable Care Act this
6:44 covers more low-income adults unlike
6:46 Medicare which is federally funded
6:49 Medicaid is jointly funded by the state
6:52 and federal government and States
6:55 administer their own programs within the
6:57 federal guidelines now what this means
6:59 is that the coverage and eligibility
7:01 will differ in Medicaid from one state
7:04 to the next navigating health insurance
7:06 is super tricky but get out of pen and
7:07 paper because I'm going to share with
7:10 you 10 tips to help you stay on track
7:13 number one understand your plan I
7:14 literally want you to read the plan
7:16 thoroughly so that you know what's
7:19 covered and what isn't please spend
7:21 particular attention to what are the
7:23 exclusions and what are the
7:26 preauthorization requirements number two
7:29 combat denials if an insurance client is
7:33 denied Don't Panic there's a process
7:35 where you can effectively combat the
7:37 denial now this takes some time and you
7:40 often times will pair or partner with
7:42 your healthcare provider you're going to
7:44 need to read carefully why it was denied
7:46 to understand the reasons for example
7:49 maybe it was out of network or maybe a
7:51 prior authorization wasn't completed
7:53 properly or maybe there wasn't adequate
7:55 documentation you want to help your
7:57 healthc care provider collect all that
8:00 documentation and they will oftentimes
8:03 on your behalf apply for an appeal now
8:06 all insurance companies have an appeals
8:08 process and so you want to read
8:10 carefully through the appeals process
8:11 you want to make sure that all the
8:14 required documentation like the doctor's
8:16 notes and things like that are included
8:18 and you want to pay particular attention
8:20 to the timelines of when that appeal
8:23 needs to be applied for lastly be
8:26 persistent it's important to follow up
8:28 so feel free to continue to call the
8:30 insurance company to find out how the
8:32 appeals process is going and please
8:34 document each time you talk to them so
8:37 you can keep track number three is to
8:39 leverage co- insurance so it's important
8:41 that you understand your co- inssurance
8:44 requirements this is the amount of money
8:46 that you're going to have to pay after
8:48 you've met your deductible and so for
8:50 example if your particular plan has a
8:52 20% Co insurance after you've paid your
8:54 premium and after you've paid your
8:56 deductible you're going to have to pick
8:59 up 20% of that Healthcare cost and then
9:01 that allows you to budget correctly so
9:03 that you have the funds to do that
9:06 number four is to use preventative
9:09 Services most health insurance companies
9:11 provide preventative care at no cost so
9:13 take advantage of that by participating
9:15 in preventative care for example
9:17 screenings you can pick up medical
9:19 problems early and Stave them off before
9:21 they become out of control and rather
9:23 expensive to treat number five try to
9:26 stay in network as mentioned earlier in
9:28 Network Services are provided to you
9:30 within your insurance at a reduced rate
9:32 going out of network can get really
9:36 really pricey number six keep accurate
9:39 records this is really important save
9:42 all of your explanation of benefits save
9:44 all of your bills and save all of your
9:46 correspondents with insurers this is
9:49 going to become invaluable if later you
9:52 have to fight a denial or a
9:55 claim number seven communicate with your
9:57 provider it's critically important that
9:59 you verify that your provider is is in
10:02 network and you always want to discuss
10:05 cost upfront to avoid any unpleasant
10:08 surprises number eight is to maximize
10:10 open enrollment once a year there's an
10:12 opportunity typically to change your
10:14 plan you don't want to let that
10:16 opportunity pass you by during open
10:19 enrollment spend some time making sure
10:21 that your insurance is the kind that's
10:22 going to help you the best in the
10:25 upcoming year if you need to change
10:27 Insurance products you can only do that
10:29 during the open enrollment period number
10:31 nine ask for help every insurance
10:34 company has a benefits coordinator call
10:36 them and have them help you navigate
10:38 through this entire process that can be
10:41 really useful number 10 consider
10:43 programs that will help you reduce cost
10:45 for example if you're struggling to pay
10:47 for high medication prices there are
10:50 programs like good RX these are
10:52 discounts and coupons which will
10:55 literally help you decrease the cost for
10:57 the medicine when you go to the pharmacy
10:59 additionally there's programs like the
11:02 Mark Cuban cost drug company which
11:04 bypasses some of the insurance costs and
11:06 can make generic drugs much more
11:08 affordable now before we go on I'd love
11:10 to hear from you have you struggled with
11:12 an insurance company and had a claim
11:14 denied if so how did you navigate
11:16 through it and what was the outcome
11:18 please leave a comment in the section
11:20 below the viewers on the channel and I
11:22 would love to learn from your experience
11:24 now when insurance coverage isn't enough
11:26 to cover expensive medications
11:28 oftentimes the drug manufacturer
11:31 themselves can step in to help so here's
11:33 a couple ways that they do that number
11:36 one patient Assistance programs many
11:38 pharmaceutical companies will provide
11:40 medications at a discounted rate or
11:42 sometimes even free for patients that
11:44 qualify eligibility is typically based
11:47 on factors like the income that the home
11:49 generates the insurance product that the
11:51 person has and the medical need of the
11:54 individual number two co-pay assistance
11:58 programs these programs cover co-pays so
12:00 they'll pay down the person's co-pay and
12:01 they can significantly reduce the
12:03 out-of-pocket cost that that individual
12:06 will have to pay themselves number three
12:09 discount cards some manufacturers will
12:11 literally issue like a credit card a
12:14 discount card to lower the cost of the
12:17 medication Number Four free samples
12:19 Physicians can sometimes receive free
12:22 medication samples from the manufacturer
12:23 which they can give to the patient to
12:26 get them started on a medicine at no
12:29 cost advocacy in Support Services many
12:31 drunk companies have teams of people
12:33 dedicated to helping you navigate
12:36 through insurance issues trying to find
12:38 additional financial services and other
12:41 ways of accessing medications so call
12:43 them collaborations with charitable
12:45 organizations manufacturers will
12:47 sometimes partner with charitable
12:49 organizations to help fund programs to
12:51 supply medicines at reduced cost for
12:54 certain underserved populations as you
12:56 can imagine some of these initiatives
12:58 can make a world of difference in
13:00 helping you start on a medicine that you
13:02 need for your condition I hope this
13:04 video helped you demystify health
13:06 insurance in the United States remember
13:09 it starts with you becoming informed if
13:11 you found this video helpful do me a
13:13 favor and give the video a thumbs up and
13:14 if you haven't yet subscribed to the
13:17 Channel please consider doing so as
13:19 always this is Aaron boster saying thank
13:21 you for learning about Ms and in this
13:24 case health insurance with me and until
13:25 my next Monday morning video or my next
13:28 monthly live stream be safe and take care
