Ep. 113: Health Insurance 101

By: Cassy Joy Garcia
Fed & Fit
Fed & Fit

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On today's episode, we're taking a quick look at the history of health insurance and the major health insurance components.

Fed and Fit podcast graphic, episode 113 health insurance 101 with Cassy Joy

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Episode 113 Transcription

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Cassy Joy: Welcome back to another episode of the Fed and Fit podcast. My name is Cassy Joy Garcia. I am your host today. And I am excited about today's episode. So I have one of those moments, a fangirl moment, when I got an e-mail a while ago. I have been reading this Skimm; this is not a sponsored endorsement, so know that. This is just a true honest review. I have been a consumer of the Skimm for a while. It's kind of a setup as the newsletter, you plug your e-mail in and they send you daily newsletters with kind of little bite sized pieces of information of what kind of news is going on. And I really like the way that they phrase things. They make it really interesting and easier to understand. And I like having one single source for a piece of some of the news. It's more of just a highlight reel versus a fact-finding exercise. Though they do link to really great articles.

Anyway, so I have been a consumer of this Skimm articles for a very long time, and they reached out letting me know that they are currently doing a no excuses campaign on health care. And the idea behind this campaign is they really want to help educate folks on what really is the landscape of health care right now, particularly in the United States. It’s ever changing it's very confusing. And so they asked if I was interested in participating in the campaign, and I said absolutely. And I thought that a great way to participate would be to do a dedicated podcast episode. So today's show is about healthcare 101.

So what I've done is I have combined some of my research with the research that the Skimm has put together over on their website. And I will link, of course, to all of their fabulous resources that are really entertaining, full of great graphics. Makes it really fun to read. But I’ve combined our two powers that we had at our disposal to put together what I think is a really good overview of health care. Not only a history on health insurance in the country, which I found pretty interesting. But I’m also going to talk briefly about, how the heck does insurance actually work? I know that there are a lot of listeners to this podcast in this millennial age range. I myself, I am currently 31 years old, during the summer of 2017. That’s when this show is being recorded. And I think that I'm considered a millennial, as well. So our generation are, I think that the study that they put out there serving 500 folks, over half of the people are really confused by health insurance, and don't really have a good grasp on the landscape. And when we’re confused about what's going on, we tend to shy away from it. And maybe we don't know what is available to us, and how they world works.

So because you guys know me, I think that knowledge is power. Education is very powerful. I’m not here to portray any sort of particular agenda, other than just kind of tell you what’s out there, what’s happened in the past, how the system kind of works, so that you are more informed and you can make more informed decisions for yourself. So I hope that’s helpful. So we’re going to talk about the history of health insurance, how does insurance work. We’re going to talk about the differences between an HMO and a PPO. And then were going to talk about what does that mean when it comes to your costs, and what maybe is probably covered already. And then we’re also going to briefly review what's going on with health care right now, in the summer of 2017.

So, let's get into it. So healthcare 101. Health insurance, this was interesting, but I didn't know this. But it's the number one employer in the United States right now. Health insurance companies are the number one employer; make up the collective number one employer in the United States. And they also represent the sixth largest industry in the United States. And it’s a pretty intimidating topic for many reasons. It can mean lots and lots of dollars out of our pocket, which is very scary. Especially for folks who are just getting started in their careers. It involves usually a lot of confusion as to why those dollars are being pulled out of our pockets, and where they're even going. And to add to the confusion on top of that, the political landscape is ever changing. So we almost feel like we have to have some sort of a knowledge of how to filter through what’s going on over on the Hill to see what that really means as far as our Health insurance care goes.

So, let’s rewind the clock a little bit and talk about the history of health insurance. This I found very fascinating, and thanks to the Skimm for doing all this wonderful research. And this is an abbreviated list on the timeline, so if you want more of it I definitely recommend you go check out the website. And let me make sure I have the website ready here for you. It’s just www.theskimm.com/noexcuses/HealthCare. And you'll get access to everything.

Ok, let’s jump into it. So, these were some of the really fascinating pieces. In 1929 is when it all began. And a group of school teachers in Dallas, Texas signed up for insurance called Blue Cross from a local hospital. Does that sound familiar? And what they did is they decided to pay that hospital a little amount each month so that they could get all the care they needed when they needed it. Pretty brilliant. In 1939, so 10 years later, a different company or group is formed, called Blue Shield. It’s started by a group of doctors who, working similarly as Blue Cross did, and eventually the two joined together to form what we know today as Blue Cross Blue Shield. But Blue Cross was formed by the school teachers in Dallas, from a local hospital, and then Blue Shield was started by doctors. So it was kind of, you got both sides of the healthcare exchange there represented.

In 1943, is right around World War II timeframe. And it was interesting to read this. That while the workforce was slim, because so many of the workforce of that age were off fighting in the war. The government left to really work for industry here at home, there weren't that many folks. So the government decided to help encourage companies recruit folks by offering health insurance as a tax-free benefit. So that's really where companies started to get involved, and where health insurance was started to be offered as a benefit to employees. That was in 1943, because of World War II. Or around the time as World War II; I can’t say because of.

And then flash forward 20-something years later, in 1965. Medicare and Medicaid are introduced as employer-sponsored insurance. Has the rest of the population coverage. So we have employer-sponsored insurance that had started in 1943 as a perk to recruit top folks. So what the government decided to do was start Medicare, which was government sponsored health insurance for the elderly, and Medicaid, which is government sponsored health insurance that covers the lower income group in the United States. And at this point in time, flashforward to 2017, apparently Medicare and Medicaid cover more than 1/3 of Americans. Which is an incredible number of people.

In 2008, so we've jumped another 40-something years, we have more than 43 million Americans currently without health coverage. And at this point in time, many are losing their plans. Folks with preexisting conditions; think diabetes, are priced out of the market because the insurance companies don't actually want to pay for their care. It's very expensive to pay for folks who have chronic conditions. And then in 2010, the Affordable Care Act, known as Obamacare, which I will refer to it in this podcast as Obamacare, because I think that's the one that most people recognize, passes Congress in 2010 and is signed into law.

Medicaid, included within Obamacare, Medicaid is expanded to cover more low income Americans. It expands on an insurance exchange, where Americans now can shop for plans on their own. And it requires via what they call the “individual mandate”, that all Americans have health insurance or pay a fine. This probably sounds very familiar to everyone who at least watched some of the news back then. And then in 2013, three years later, www.healthcare.gov, that’s the website that exchange where folks can shop for plans goes live, and it actually has an epic glitch, and the site crashed and folks couldn't get signed up. So that was also all over the news, if you remember that.

Flashforward to 2016, so that was last year. Donald Trump is elected as president of the United States, and promises to repeal/replace Obamacare on the campaign trail with a plan that will ensure everybody, and that there will be no cuts to Medicare and Medicaid. That’s at least what he said on the campaign trail in a very small nutshell. It gets much more expansive once you dig into it. And then in May of 2017, after its second attempt at being passed, the house then finally passes the replacement payment plan for Obamacare. And this new plan dictates several things. One, that the states can now decide whether “essential benefits” that were identified by Obamacare need to be covered. Essential benefits, for example, included maternity care, annual exams, things like that. This new replacement plan also makes it legal for insurance companies to charge more for preexisting conditions, like diabetes, and asthma, you name it. It withholds Medicaid reimbursement for Planned Parenthood, which was a highly sensitive political issue in this last round, if you of course remember. And this plan also cuts funding for Medicaid.

Now, in June of 2017, we’re in the current month, the senate's turn is now come around, and they're working on their own version of a replacement plan for Obamacare. And the highlights of their plan has not been put to vote yet, as this podcast is being recorded. What it's supposed to do is cut the individual mandate. And the individual mandate, again to remind you, is that either you have a plan or you pay a fee. So they plan to cut the individual mandate, but make people who go without health insurance for two months or more to wait another six months before they can opt back in. They have articulated that in a nutshell. It caps funding for Medicaid, and it ties tax credits that help pay for coverage to income instead of age brackets. It also cuts taxes on high income Americans, that helps to pay for Obamacare. And it actually keeps Obamacare’s rule on insurance companies not been able to charge more for preexisting conditions. So that is their form of the bill.

And then let's go ahead; isn’t that an interesting review of the history? I found that very fascinating. So flashforward; how does insurance actually work? Now that we’re getting out of kind of; I wanted to stay away from the political landscape as much as possible on this episode, because gosh. There are so many ways that it could be talked about and so many different perspectives, and that's really not what I'm up here to do, is to talk about anything like that. What I really just wanted to say was just a quick overview of the landscape, so hopefully I did that from as unbiased of a perspective as possible. And now we’re going to go back into how does insurance actually work? So you as a consumer. Now that we kind of have an idea of the history, where it came from. Now what are the players? What are the pieces we’re dealing with as an individual?

So, what are all of the big terms involved in health insurance? You’ve probably heard of a premium. Ok, so what is a premium when it comes to your health insurance? It’s what you would pay each month. And that is essentially what you pay to have a right to your plan. The insurance company will keep that amount to pay for your medical costs in the future. So your premium is usually a fixed number that you pay every single month. Kind of like your mortgage or your car payment. It’s a fixed amount that you pay every single month. And if you have an employer based health insurance, that means that you probably pay a fixed amount. So maybe that's, I’m just making up numbers out of nowhere. But let’s say that you pay $200 every single month, and your employer also pays $200 every single month. And combined, that $400 represents your monthly premium. And those can be negotiated on an annual basis.

Ok, so the next term that you’ll come across is a deductible. So a deductible, it can either be a low detectable or a high deductible, is the amount of money that you will pay out of pocket before insurance really starts to kick in and cover your medical costs. So, what does that mean? If you’re paying your premium you also have a deductible after that? Yes, you do. So again, let’s make up some numbers. Let’s say if your premium is $400, and your company pays for $200 of it and you pay for $200 of it, let’s say that you also have a $2000 deductible. And let's say that’s a relatively low deductible, from what I'm familiar with and health insurance plans. So every single month you pay your $200, which is matched by your employer, and then throughout the year, let’s say you go to the doctor's office, and you go to the emergency room, and you go and you have prescription medications. And essentially what that means is for the first $2000 of expenses, your insurance company will then bill you for those costs. And I’ll talk about how those prices are negotiated in a second. But they bill you up to $2000. Then after you personally have paid an additional $2000 out of pocket, then insurance starts to kick in.

So a low deductible situation means that you probably are paying more each month; you have a higher premium, but you have a lower deductible. A lower out of pocket until insurance kicks in. And then a high deductible scenario typically means you have a lower premium. So you pay less each month, but it means that you have a higher deductible to meet once insurance kicks in. And there are different people who will choose different plans for different reasons. I was a very, I’m a very accident-prone person. At least I was for a long time. So I tended to always opt for a low deductible plan, because I knew I was going to need it. Right? If you know you're going to have those medical costs, that’s a good way to go. This is, again, just my perspective and how I made those decisions. But if you are somebody who is very young and has no reason to be concerned for any; maybe you’re single and you're not planning on getting pregnant. You know, those kinds of expenses can roll up, then a high deductible situation is something that I see a lot of young people opt for, because they know that they're not really going to meet that deductible anyways, so they’d rather pay less each month. So that’s kind of how those two work.

Now, let’s talk about a copay. A copay is the payment that you would make every time you actually have a doctor appointment. And note that some preventative annual visits don’t actually require a copay. So, for example, some ladies listening know that their women's wellness exams don’t require a copay. That could be why. A copay, just to give you an average number, could be maybe $45. Right? So an in-network physician visit could be a $45 copay. And what that means is you go to the doctor's office, and the insurance has already decided that you the patient are going to pay $45 worth of those services. And that’s just a flat fee.

OK, so what’s another term that you’ll probably come across? Another term that you may come across is benefits. And these are the services and medication, anything that you might take, that a health insurance plan will help cover. So when you call your health insurance, and you're curious about whether something is covered, you would ask to speak to somebody about your benefits. Right? You would say, I need to know if this test is covered. That would be included under your benefits.

Another term that you'll probably come across is called a claim. What the heck is a claim? I tell you, this is a whole different world. And I worked in a doctor's office for a while, so I became very familiar with this stuff. But I realized that not many people do if you haven’t had that kind of experience. Or, heaven forbid, you haven't had a whole lot of medical issues where you’ve had to deal with these things. Ok, so a claim is essentially a bill. It's a claim sent by the doctor to the insurance company claiming what is owed to them. So after you go to the doctor, the doctor will see you, right? And that may cost a certain amount for the actual time and any services that are rendered. So let’s say you have a broken arm. You go to the doctor, and your bill essentially starts to tick off while you're there. So they say, well I spent an hour with you and my hourly rate is X amount of time for that. So I’m going to bill this much for my time. And we had to set your arm, so that was a particular service, so we're going to have to bill for that. And then we had to use a cast, and use this material, and put that on, apply it, and give you a sling. So those items have hard costs, as well. And let’s say you have a shot, that also has a cost associated with it. And let’s say you saw the nurse; a nurse visit will have a cost associated with it.

So they will take the grand total, that whole list of all the different services and products that you received while you were there at your doctor's office. And they will put a detailed list together, and each one of those services and products has a specific code attached to it. So they will take that list of things. You’re gone. You’ve already gotten your arm set, and it's got its cast on, and you’re on your merry way. So what the doctor does at this point is they say, the doctor’s office needs to get paid. So they have not received payment yet for those services, so they will submit a claim to your insurance company and say, “Hey insurance company, this is what you owe me.” So they send them that number, that grand total. And then what the insurance company will do, and his goes into my next topic, is negotiated price. The insurance company will then look at that list of services according to code, and they will say, “I see that your billable rate,” let’s say that doctor spent a whole hour with you, and they billed you $300 for that hour. The insurance company can say, “I see that you billed us $300 for that hour, but I’m actually going to discount that because I think that your price is too high. So I’m going to discount it by 50%, to $150 an hour.” So even though you billed me, you submitted a claim for $300 dollars an hour, I’m going to say that only $150 of that is allowable. Ok.

And so what the insurance company does is they will go through each line item, each service, each product, and they will submit essentially what they consider to be an allowable amount. So they will apply their own discount, which they can do because they have all the customers. Right? They have you, the insured, all the customers. And they will apply whatever discount they deem necessary, and then they will send that amount back to the company. And they will say, here you go, company. So of your total bill, we discounted it by a grand total of let’s say 40%, and we're going to go ahead and cover. Let’s say if it was an annual exam or some sort of something you would have every year, a physical, we’re going to go ahead and cover 100%. Or, if it was actually a broken arm, they’re going to say, so we discounted it 40%, so the remainder is due to you by the patient. Because the patient has not met their deductible yet. So the doctor's office will send a bill to you, the patient, and you the patient will then pay the doctor's office the remainder of the bill. And that amount of however much you wrote that check for will count toward your deductible. I hope this is as clear as mud. {laughs}

OK. And so what's interesting is that doctor’s offices will work with certain insurance companies to be deemed in-network. Right. So when you call your insurance company and you're trying to figure out if you can go see a certain doctor, you want to ask them, is this doctor in-network or out of network. Ok? And an in-network doctor; what does that mean? An in-network doctor means that that doctor has already prenegotiated reimbursed allowable rates with the insurance company. So that doctor, even though they bill, let’s say $300 an hour, they know that the insurance company is going to discount it by X amount of percentage. So the doctor's office can already kind of do some financial forecasting for their office, knowing on what they’ve negotiated with the insurance company that they're going to allow. Which is pretty interesting how that works.

So what that usually means for you as the patient/the consumer is that the negotiated rates, not only do they work to the benefit of the physician and the insurance company, it probably works to the benefit of you, the patient. It probably means that the insurance company is more likely to cover certain costs at that doctor's office, and it probably means that the rates are going to be a little bit better for you. So, just something to consider.

And then an out of network physician is going to be more out of pocket. And so what that means is let's say you wind up going to a specialist on a whim, and you get a bill, and it says it will count towards your maximum out of pocket deductible, but it will not count towards you're in-network deductible. So what the heck does that mean? That means that you saw a doctor who was not already negotiated in-network with that insurance company, so the insurance company will negotiate rates on your behalf, and they will send you a bill now for the amount that you owe. It's probably going to be that you’ll owe a slightly higher percentage, because they’re out of network and they haven’t negotiated rates with that doctor's office. And it probably also means that it's going to apply to a slightly different deductible.

So let's talk about what a maximum out of pocket deductible is. So you're in-network deductible is the one that most people chase. If you have kids, or you have already a lengthy medical list of procedures and folks that you have to see. And gosh medical costs in general. If you know it’s relatively high, you're probably constantly trying to hit that in-network deductible, and then you're trying to stay in-network. Because if you're in-network deductible; let’s say it’s $2000. Let’s say you hit that $2000 deductible, if your insurance starts in January, let’s say maybe you hit it by March. OK. So at the beginning of March, it means you’ve paid $1000 in January and $1000 in February, both went towards your deductible. Both of those who probably covering doctor's office visits and maybe medications and things and so on.

So in March, you're completely covered. Your insurance company now is going to cover those doctor visits, and is going to cover those medical costs, and those medications, and things like that. But what if you go and you see a doctor that's out of network? Then all of a sudden, the cost of that visit will get applied to a separate deductible. Ok, so that's why most folks like to stay in-network with their insurance company. But you do have a maximum out of pocket. So whether it's in-network or out of network, there usually is a big number. I'm thinking of one that I saw once that was like $12,000. So by the end of the year, you have a maximum out of pocket of $12,000. So if you do have to see somebody that's out of pocket, or you do have a medication that's not covered that is prescribed to you, your maximum amount of money that you're ever going to have to pay is going to be that big number. So that’s why there are several different deductibles.

Ok, moving right along. Let’s talk quickly and what an HMO is and a PPO. So these are two phrases that we’re probably hearing a little less and less in recent years, but it was very prevalent not very long ago. They’re still out there and I think it’s still something worth reviewing. So an HMO; these are two different kinds of insurance plans. And there are some insurance companies that have done away with one or the other, and they just call it health insurance now. So if you don't have one labeled as one or the other, that's why. And you can ask your insurance company, of course, for more information on that.

So an HMO stands for health maintenance organization. And a PPO stands for preferred provider organization. So an HMO, what's involved there? What you usually get is the lowest pricing. So it may cost you lease amount out of pocket, but it also involves the least amount of flexibility. So what that really looks like, is let's say your HMO plan requires you to have a personal care physician, a PCP. It requires you to have, that’s your main doctor. Right? Your main guy, your main gal that you go and see on a regular basis. And that main person has to be approved by your HMO plan. Has to be in-network with your HMO plan. And that physician, that primary care physician, that PCP, is the only one that can refer you to another doctor or another specialist. They’re the only ones that can order certain tests. You can't just go out and order them, and you can’t just go and see a different specialist on the fly.

So an HMO does not have a lot of flexibility, because your primary care providers is the one that has to really coordinate things. And you can only ever really work with in-network physicians with your HMO. Plan.

Now, a PPO plan, the preferred provider organization, slightly usually more expensive, but also offers more flexibility. So in contrast to the HMO, you don't usually need a referral from your primary care physician, and you're out of network visits with other doctors are more likely to be covered. So those are the two main differences. And those differences, of course, are going to vary greatly based on where you are in the country. Actually, depending on what state, and what's going on currently with the political climate. So just keep that in mind, and ask lots of questions.

Okie dokie. So, what could be your cost then? So if you have employer based health insurance, meaning that in a very traditional sense, you have a good old-fashioned job and your employer offers you health insurance, which is something of course that we now know started back in World War II timeframe. Last year the Skimm put together an average number for us, but they said that the average for a single person last year was $6400, between what you and your company paid towards the plan. This does not actually include anything outside of that. That's just the premium part of it. Ok, so $6400 an average. When it's a governing run exchange, so let’s say you're out there, either you opt for health insurance on your own, it could be much higher. And those rates are extremely variable. Medicare and Medicaid are government run, o if you are approved for either of those, you’re likely cover entirely.

Cobra; what is Cobra. Cobra was actually put into place by Congress in the 1980s to protect those who lost their jobs suddenly, whether they were fired or had workforce reduction. Whatever it was, it was meant to protect those who suddenly had no job, so they maybe had no health insurance because of that. And we always hear the Cobra is expensive; I'm sure some of you have heard that. So why is Cobra expensive? Cobra is expensive because now you are paying both your portion and the portion your employer paid towards that premium. OK? So it’s going along with the same example of, if you’re paying $200 each month towards your premium, that shows up on your paycheck is that's what’s taken out towards your health insurance, your employer is also paying $200 a month. So when you go on Cobra, all of a sudden the full $400 becomes your responsibility.

And then what is your cost when it comes to Obamacare for example, the note I have here is actually not free. Because while the law currently helps cover some folks depending on income, even the free services, like annual checkups, birth control pills, things like that, are paid for by your tax dollars. So it always comes from somewhere. OK.

So what is probably covered by your health insurance right now? I think this is a good thing to quickly review. Things to be aware of. If you have health insurance, these are good things to take advantage of on a very regular basis. They include all of your preventative appointments. So what would qualify for preventative appointment? That would be something like maybe the dermatologist. You can probably see the dermatologist. You can probably see your optometrist. You can probably see your OB/GYN for your women's wellness exam once a year. All the ladies. You can probably get your annual physical once a year from your primary care physician. And if you opt for a flu shot, for example, those are usually included on an annual basis. So those are things to just kind of be aware of. Those are likely covered.

Now, know that this varies very greatly, what is and is not covered changes day to day, plan to plan, company to company. It is a moving target. So if you're ever confused and want to learn more, just call your health insurance provider, and ask them some questions.

Ok, so just to recap. What’s going on with healthcare right now? Well, the landscape is ever changing. So that is nothing new. It is definitely changing very quickly at this point in time. In the last 10 years, a lot has been going on. The U.S. currently has the most expensive health care system in the world. And so that's why it is tip-top of the news. It affects absolutely everybody. And making any kind of change, this is to quote the Skimm. I loved what they said here, but making any kind of change to the healthcare system is a hugely complicated thing to do. Remember we said that it's the number one; health insurance companies represent the number one employer in the United States, and the sixth largest industry in the U.S. So, making any kind of changes to the industry is very complicated, and it will always have lots of unintended consequences, which is why, no matter what Congress does, there will always be lots of people who are not happy. That’s just kind of the only solid thing to predict; is that there's no solution that’s going to please absolutely everybody.

But at the end of the day, know that hopefully you're a little bit more informed now. You feel a little more empowered to go ask some questions. Do your own research. Like I said, I’ll link to everything that the Skimm had put together. It was wonderful. They even have a get the Skimm care calendar. So it's an app that you can download to help you schedule out when you want to get some of those most likely preventative covered appointments. They have all kinds of Q&A on there. They have that expanded timeline that I talked about. They have a full Rolodex essentially of the key players in health insurance when it comes to kind of the political landscape side of it, and who was involved. Where are we now, and then they also have a full on; they call it their skimmationary. It’s kind of like a dictionary, but a very quick review of all the big names and things you'll come across when it comes to health care. So I love it. I love the way they do news.

I hope you guys enjoyed this episode, and I hope, of course, like I said, it answered some questions for you. As always you can find a full transcript of today’s show over at www.FedandFit.com. And if you like this show, it would really mean a lot if you would head over to iTunes and leave a review for the Fed and Fit podcast. It will help get the show in front of more and more folks. Thank you so much for joining us today. We’ll be back again next week.


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  1. Katherine says:

    This was a wonderful overview, Cassy! Being a young woman trying to navigate my own healthcare for the first time has been nothing short of infuriating at times so having a basic understanding of what it all means is so helpful! I also love that you were able to go over it all so objectively – that is not easy to do in today’s political climate. Thank you for all of your help – you truly are amazing!

  2. Paige Brogan says:

    I’m surprised you didn’t speak to the integrated care model, such as Kaiser.