Look Inside Young Adult Road Map

Piecing Together the Insurance Puzzle
Why learn about insurance? If you know the system basics of health insurance, it will be
much easier to understand maps and talk to guides. You can make better choices. You can
avoid getting stuck with an insurance plan that costs too much or doesn’t pay for or cover
the services you need.
Every insurance plan is a kind of puzzle made up of four basic parts:
1.
2.
3.
4.
Premium: This is the amount you pay the insurance company to belong to the plan.
In some plans, this premium is subsidized (paid for by a government agency). That
part may change if your income changes—for example, once you get a full-time job.
Coverage: This piece of the puzzle looks at the types of services the plan will pay for,
and who can provide you with those services (in-network providers). Your plan
may still pay a smaller amount if you use providers who aren’t on that list (called
out-of-network providers).
Out of Pocket: This piece concerns two ways you may still have to use your own
money to pay for some services. You may have a “co-payment” or “co-pay,” which is
an amount you pay every time you see a certain provider. You may also need to pay
a certain amount of money for your health care treatment each year before the insurance
company starts to pay. This is called a deductible. (Sometimes insurance plans
with low premiums can have fairly high co-pays or deductibles.)
Limits: The last piece of the puzzle has to do with things your insurance plan will NOT
cover. “Caps” are limits on the amounts of money the insurance plan will pay for certain
services. Exclusions are types of services for which the plan will not pay. An annual or
lifetime maximum benefit is the greatest amount the insurance company will pay for
a certain type of service over one year (or the entire time you have that policy).
Lifelines
Below are two links to sample
crisis plans:
https://magic.piktochart.com/
output/3641390-how-to-create-asafety-plan
(National Suicide Prevention Lifeline)
http://mentalhealthrecovery.com/
wp-content/uploads/2015/07/
CrisisPlan2012Manual.pdf (http://
mentalhealthrecovery.com/
contact-us/)
These are two apps (iTunes) for
crisis/safety plans:
n Suicide Safety Plan
n Be Safe
1.
The Premium Piece
How much will I pay for this
policy (plan)? How often will
I pay this? What happens if
my income changes?
3.
The Out of Pocket Piece
What will I pay at the time
I get services (co-pay)
or before the insurance
starts paying (deductible)?
2.
The Coverage Piece
What types of benefits
does this plan cover
and what providers
can I use (network)?
4.
The Limits Piece
When does my plan stop
paying for certain services
(caps)? What services are
not covered (exclusions)?
Editorial Board Notes
Contributed by: Alyse Schwartz
23