Asking a few questions about your health insurance and knowing your options can protect your wallet after a doctor’s visit.
1. Know your options
How much you’ll spend at the doctor depends on what type of doctor you visit. Most plans will cover a phone call with a nurse, an online doctor visit, or visits to a doctor’s office, an urgent care clinic, or a hospital emergency room. Nurse lines and online visits are usually cheapest (and often free). Emergency rooms are the most expensive.
2. Ask if the doctor is in your plan’s network
Most health plans have a network of doctors, specialists, and other providers. You’ll pay more if you get care outside the network. Ask your health plan if the doctor, facility, or hospital you want to visit is in your network. If you go to a doctor outside your network, ask the doctor about the cost. Some might be willing to negotiate lower prices with you.
3. Ask how to save money on prescriptions
Most plans have a list of drugs that they will pay for. The list also shows how much you’ll have to pay. If the drug is too expensive, ask your doctor if there’s a generic version. If you choose the brand-name drug, there may be coupons or discounts that can save you money. Ask your pharmacist where you can find coupons.
4. Ask questions if you get a bill
If the visit was covered by insurance, don’t pay more than the explanation of benefits from your health plan states you may owe. If the bill was for more than you were expecting, ask the doctor or facility for an itemized bill. Look for errors or duplicate charges. Call your health plan if you have questions. You can also ask the doctor for a discount or an interest-free payment plan.
For more information, click here.
- Ask students whether they or their family members have requested from their physician and pharmacist if a less expensive drug is available?
- Are you aware that many states offer state pharmacy assistance programs that help pay prescription drugs based on financial need, age, or medical condition?
- Have you considered using a mail-order or legitimate online pharmacy for your prescriptions, especially if you will take a drug for a long time?
- What are your options to get the medical care you need and avoid a big bill?
In September 2019, the U.S. Census Bureau published a report on health insurance coverage in the United States. The report is based on information collected in The Current Population Survey Annual Social and Economic Supplement and the American Community Survey.
Here are some of the highlights from the report:
- In 2018, 8.5 percent of Americans, or 27.5 million people, did not have health insurance at any point during the year.
- The percentage of people with health insurance coverage for all or part of 2018 was 91.5 percent, lower than the rate in 2017 (92.1 percent).
- In 2018, private health insurance coverage continued to be more prevalent than public coverage, covering 67.3 percent of the population and 34.4 percent of the population, respectively.
- Between 2017 and 2018, the percentage of people covered by Medicaid decreased by 0.7 percentage points to 17.9 percent.
- The percentage of uninsured children under the age of 19 increased by 0.6 percentage points between 2017 and 2018, to 5.5 percent.
For more information, click here.
- Ask students if they have health insurance of their own or through their parents. What are the premiums for their coverage?
- Ask students to make a list of available sources for private and public health insurance coverage in their states.
- What might be some reasons why 8.5% of people, or 27.5 million, did not have health insurance in 2018?
- While most people have a single type of health insurance, some people may have more than one type of coverage during a calendar year. Why?
If you’re looking online for health insurance, there are lots of results that seem to offer good choices. But dishonest companies are literally counting on you being confused by all those choices. So, before you sign up and pay, take steps to know you’re getting exactly what the plan advertised. Otherwise, fake “coverage” can leave you exposed to substandard benefits and costly payments.
For example, according to the Federal Trade Commission, a Florida-based company, Simple Health Plans, LLC, allegedly tricked consumers into believing its plans offer comprehensive coverage and are compliant with Affordable Care Act (ACA) standards. The company allegedly lured people in through lead-generation sites, using logos of well-known health insurance providers to make itself look credible. Simple Health asked for personal information on the site, followed up with phone calls, and pitched what it said were affordable, comprehensive, ACA-qualified plans with low or no co-pays or deductibles.
But once consumers signed up — often at premiums as high as hundreds of dollars per month — the FTC says they did not get anywhere near the full coverage Simple Health promised, and the benefits were not ACA-qualified.
For more information, click here.
- Ask students if they or any of their friends and relatives have received sham health insurance plans calls. If so, how did they handle such calls?
- Help students understand that two best-known and legitimate sources of the government health insurance are Medicare and Medicaid.
- What are some ways to protect yourself against false health care plans?
- Why is it important to learn the difference between health insurance and medical insurance discount plans?
“I’ve been told a high deductible health plan (HDHP) is a good choice for my situation and that it might save me some money. Can you explain this to me.”
This Forbes article provides answers to the questions that many people–especially younger people–have about high deductible health insurance policies. At the beginning, the author, Christina LeMontagne, points out that high deductible policies are a great option for healthy people, but may not be right for everyone. She also describes what a high deductible health plan is, who can benefit from HDHPs, and how they can save you money.
For more information, click here.
You may want to use the information in this blog post and the original article to
- Reinforce what a high deductible health plan (HDHP) is.
- Stress the fact that while an HDHP may save you money, there are risk involved if you choose this type of policy.
- What are the advantages of an HDHP plan?
- What are the disadvantages of an HDHP plan?
- Under what circumstances would you choose an HDHP plan?
Certain provisions of the Affordable Care Act will probably affect your federal income tax return when you file this year. The law requires that you and each member of your family have qualifying health insurance coverage for each month of the year, qualify for an exemption from the coverage requirement, or make an individual shared responsibility payment when filing your federal income tax return.
Most taxpayers will simply check a box on the tax return to indicate that each member of their family had qualifying health coverage for the whole year. Qualifying health insurance includes coverage for most, but not all, types of health care coverage plans. If you bought coverage through the Health Insurance Marketplace, you should receive Form 1095A, Health Insurance Marketplace Statement from your Marketplace by early February.
For more information, Click Here.
- Ask students to search the Internet to gather more information about the new IRS requirements and the Affordable Care Act.
- What are provisions that might affect an individual and their families?
- What are the reporting requirements when you file your federal income tax return this year?
- How can you determine if you are eligible for an exemption?
- What should you do if you are expecting to receive 1095A and you don’t receive it by early February.
In September 2014, the Internal Revenue Service announced the availability of new You Tube Videos to help taxpayers get important information about the Affordable Care Act and tax return filing. These videos on IRS You Tube channel discuss the premium tax credit and the individual shared responsibility provision. These provisions of the Affordable Care Act will affect tax returns beginning with the 2014 filing year.
In the premium tax credit video, the IRS Commissioner explains how it can help make purchasing health care through the Health Insurance Marketplace more affordable for people with moderate incomes.
For additional information on the tax provisions of the Affordable Care Act go to
You may want to use the original article to discuss
- What are the criteria used to be exempt from the Individual Shared Responsibility provision?
- How and where can you obtain an exemption?
- Who is subject to the individual shared responsibility provision?
- What you need to do if you want to be sure you have minimum essential coverage or an exemption for 2014?
- What will you have to do if you don’t have or don’t maintain your health insurance coverage?
- If you don’t have health insurance coverage or qualify for an exemption, how and when must you make an Individual Shared Responsibility payment?
Health Insurance and the Patient Protection and Affordability Care Act of 2010 created state-based health insurance marketplace (also called insurance exchange) through which individuals can purchase health insurance coverage.
Open enrollment in the Health Insurance Marketplace ends on March 31, 2014. The next open enrollment period for 2015 coverage starts from November 15, 2014 and ends on February 15, 2015. There are several ways to sign up for Marketplace plans, but applying online is the quickest method to get coverage. You can buy a marketplace plan directly from an insurance company, with the help of a broker or an agent, or using an online service. If you can’t afford a health plan or can’t wait until coverage begins, you can get low-cost care at a Community Health Center near you.
For additional information about the Health Insurance Marketplaces go to https://www.healthcare.gov/what-is-the-health-insurance-marketplace.
- What are several methods of getting health insurance coverage through the Health Insurance Marketplaces?
- Can a Marketplace refuse the coverage or charge you more because you have an illness or a medical condition?
- How do you choose a health insurance plan that is right for you?
You may want to use the information in this blog post and the original source to discuss
- The 5 categories of Marketplace plans: Bronze, Silver, Gold, Platinum, and Catastrophic.
- How you may be able to get lower costs on deductibles, copayments, and coinsurance?
- How to apply and enroll in health coverage in the Marketplace?