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