2 weeks ago

Look Inside Young Adult Road Map

2 Guiding Star Point

2 Guiding Star Point Two: Learn System Basics In our American health care system, a lot depends on your insurance benefits. Getting Medication Facts If medication is part of your treatment plan, here are some questions you might ask the doctor or nurse: 1. How will this medication help me? 2. How commonly is the medication used by people my age? 3. Is this a brand-name medication? Is it available in a less expensive generic version? 4. What is the name of the generic version? Can I use it? 5. Can I switch between brands or between the generic and the brand-name medicine? 6. What is the dosage? Is it likely to change during the time I am getting used to it? 7. What if I can’t swallow a pill or capsule? Is it available in chewable form or liquid? Can a pill be cut in half? 8. Will I need any laboratory tests with this medication? If so, how often? Part Two: Health Insurance Coverage Finding out what service you need is only part of the picture. Getting that service paid for is the other part. Most people find health insurance paperwork confusing at one point or another. It can look like an endless pile of forms covered with number codes and terms you don’t understand. However, the information on those forms determines whether you get the treatment you need paid for by the insurance company. In our American health care system, a lot depends on your insurance benefits. Benefits are payments made by the insurance company for services you receive. Sometimes this is called your coverage. Those benefits are part of a contract between you and the insurance company called an insurance policy or insurance plan. The rules of that plan may be complicated, and they may change over time. That’s why there are MAPS and GUIDES. MAPS are different forms of written information (such as a health plan member’s handbook, an insurance plan website, or a government website) that explain benefits and procedures. These resources may tell you where to look for more information or what organizations can help you apply for benefits. GUIDES are people who know about different parts of the process, such as customer service associates for insurance companies, case managers in Community Health Agencies, advocates, or staff in a medical office. (For customer service, call the number on the back of your health insurance card, if you have one.) 22

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: output/3641390-how-to-create-asafety-plan (National Suicide Prevention Lifeline) wp-content/uploads/2015/07/ CrisisPlan2012Manual.pdf (http:// 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