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Health Insurance 101

Health and Wellness

In this episode we’ll take a look at what health insurance is, the different types of insurance available and some tips for picking the kind that’s right for our needs. With 30 years of experience in the health insurance industry Dorane helps us answer many of the common and confusing questions about this topic.

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Hosts

  • CJ Anderson
  • Dorane Brower

 

What is health insurance?

Health insurance (much like other forms of insurance) is a group of individuals coming together to care for each other during times of high need or expense. We pool our resources to take care of the few individuals who have great need at a specific time.

Why not just save my money and take care of my own needs when something happens to me, if it does at all?

It’s hard to predict when a crisis will happen. Many major health events also come with significant cost.

Different types of health insurance plans

  • Government plans (Medicare, Medicaid)
  • Commercial (Through an employer or health plan)

Some employers offer multiple plans, or we may have to find our own plan if we don’t have coverage through an employer. What things should we look for when selecting a plan?

The easiest choice can be to stick with what we have, but it’s important to look at your current (and anticipated) needs, as well as the benefit options available. Things to consider include:

  • Consider the costs associated with a plan. This includes more than the monthly premium or contribution (how much you pay monthly to be on the plan). In addition to this cost, be sure to look for other out of pocket expenses. These can include terms like: Deductibles and Co-insurance limits. Think about how you will realistically use your health insurance benefits in the coming year (approximate number of doctor’s visits you expect to have. Are you planning to have a baby? Are you considering knee or hip surgery?) Look at how some of these things may be covered and what they will cost you in addition to your deductible.
  • Benefit Structure. Every health insurance plan covers a different combination of services. Some include more benefits than others. Most include coverage for different prescriptions and services, but have you checked your plan to see if things like chiropractic visits, acupuncture, massage, or even gym memberships are covered? If these things are important to you it’s possible that bundling them in your health insurance could save you money rather than paying for them separately. On the other hand, if you’re not interested in these things you may want to choose a plan that doesn’t include them, as it may save you money.
  • Chances are you have a preferred hair stylist. They’re someone you trust to understand how you like your hair styled and maybe you really enjoy their personality. The same rules apply to doctors. There are many different philosophies of care and personalities. To get the most out of your healthcare experience it’s important to find a provider who understands and supports your wellness goals, and the path you plan to take in order to get there. Once you find that person, make sure they are included in the health plan you are selecting.

What does “Population Health” mean?

In the past, healthcare providers have focused on one patient at a time. Population health asks the healthcare industry to look at health in terms of communities. They’re asked to behave differently and to ask themselves, “How can we collectively make this whole community healthier?”

In the real world this means looking beyond simply treating the immediate symptoms of disease. Instead of asking “How can I fix this right now?” it’s asking “Why did this happen and how can I make sure it doesn’t happen again for this person, and for others who might be doing the same things that caused this person to become sick?” About 70% of today’s illnesses are caused by our behavior. Population Health is about providing information, support and coaching to help communities understand and experience the health benefits of changing their behavior.

Resources

Author: LivingWell PDX Blog

Adventist Health is committed to creating a healthier Portland community.

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