Health Insurance explained

Health Insurance explained

Learn about healthcare in the USA, as you practice your listening skills.

Transcript:

Millions of us now have health insurance under the ___________ ________ ______or what some people call ___________. But like many things in life, your health insurance can often be __________ and ___________. Whether you've been insured for years or you're new to the game, understanding your ________ is important to your health and your ________. First things first: you have to pay your __________ every month or your insurance could get ___________, kind of like your cable subscription. You can also think of it like a shared health care _______ bank - we all chip in each month, even if we're _________, so the money is there when we need it. 

If you get ___________at work, your employer probably pays most of your premium and the rest comes out of your ___________ automatically. If you have Medicaid, you most likely don't have to pay any premium at all. The federal government and your _______ take care of that. If you're insured through a new health insurance marketplace, depending on your income, you may be eligible for a tax credit that pays a _______ of your premium. Once you have that shiny new insurance _________, you'll want to try really hard to keep it in your wallet to better your odds at staying healthy. Be sure to take advantage of the free preventive _________ that all new insurance plans provide. But of course, stuff happens. That's when insurance really _______ in handy. Now, having insurance helps a lot, but it doesn't mean all your health care is going to be _____. There are lots of details about your insurance plan that affect how much you pay when you get sick or injured. If you have Medicaid, a lot of these services can very well be free, otherwise you'll likely have to pay something when you go to the doctor or fill a _________. This is called a ______ when it's a specific dollar amount like $25 per visit or coinsurance if it's a percentage of the bill. There's also the __________. That's how much comes out of your own_______ before your insurance starts paying. Depending on your plan you might have a deductible for all your care or it might only apply to some types of care, like hospital stays and prescriptions. So read your plan material, because it could add up to _________ of dollars. Another important part of your plan is the out-of-pocket maximum. This is the most you'll ever have to pay in any one year, at least for the benefits your plan covers. Your insurer will pay a hundred percent of anything beyond the maximum for the rest of the year. It can be just as confusing dealing with prescriptions. Your plan has a list of drugs that will pay for called a formulary, but the prices vary. Check with your doctor or pharmacist because a generic drug might fix you up the same as a brand-name drug, but the price difference could be huge. So, those are the costs typically involved. But remember that they'll be affected by your insurance plans provider _______. This is a list of doctors and hospitals that are connected to your plan. Insurance companies negotiate discounts with these providers. Stay in-network and the discounts get passed to you. Go out of network and you could end up paying full price. And remember that out-of-pocket limit? It won't work if you go out of network. In some plans like HMOs or EPOs, your insurance would pay nothing if you go out of network. In other plans, like PPOs, your insurance will cover you no matter where you go, but you'll pay a lot more if you go out-of-network. Also, if you want to visit a specialist like an orthopedist, some plans require a referral from your primary care doctor. Sound easy enough? Well, sometimes staying in-network can be tricky. In a hospital it's possible that your surgeon could be in network while your anesthesiologist is not. If this happens to you, don't be afraid to ________ with your provider or file an appeal with your insurer. So, as you can see, there's a lot to think about when you choose an insurance plan each year. Some plans may have low premiums but fewer doctors or hospitals and high deductibles. There are trade-offs and understanding and choosing among plans isn't always easy. Remember: if you have questions, call your health _____ and ask or check with your hospital or doctor if you still have questions. Your state insurance department or _________ assistance program can help. With the Affordable Care Act there's new support for consumers, so take advantage of it. Having health insurance ______ is a good thing, especially when you know how it works. We hope you're now better prepared for the next time you have to pull that insurance card out of your wallet. Stay _____, America.


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