How UME Helped Me Navigate my Health Insurance! 

One of the things we love to do here at Breathing Room is show people how University of Maryland Extension (UME) can help them with day-to-day challenges. We have tons of classes and resources all focused on helping people make positive changes in their lives. Today, I thought I would share the story of how one of those resources helped me navigate a particularly confusing situation with my health insurance. 

I don’t think it’s a secret that health insurance can be really confusing. When I started working for UME, I didn’t know much at all about how my insurance worked. But, I actually wasn’t too concerned about it. I had always been on my mother’s insurance and she had always helped me with it. Then, I got certified to teach our Smart Choice, Smart Use program and learned so much about the ins and outs of insurance! Now, I often get to teach people (including my own friends and family) about how health insurance works. I didn’t even realize how much my own confidence had increased until I ran into a problem with my insurance. 

It all started with my going to the doctor for a regular checkup. I wasn’t concerned, until a few weeks later I got a bill for $400 and a letter saying my visit wasn’t covered. Because of all I had learned, I knew my visit should have been considered preventive care and I knew my doctor was in-network for my plan. So, the visit should have been covered and I shouldn’t have had any out-of-pocket costs. 

I called the insurance company to get an explanation and they let me know they would look into it and get back to me. After not hearing back for a few weeks, I called again. The issue appeared to be that the health insurance company was confused about whether I was still covered under my mother’s insurance after getting married. We spent so long going back and forth, that I actually started getting calls from a debt collection company. I still refused to pay because I knew the visit should have been covered! 

Finally, the health insurance company resolved the problem and paid for the visit. After receiving confirmation the bill was paid, I wrote a letter to the debt collection company asking them to verify the debt, which basically means the debt collection company has to go back and make sure the original debt is still valid (I also learned about this from UME, we have great classes about credit and debt!) Finally, the company stopped contacting me and everything was resolved. 

Recently, I was thinking about how differently this whole situation could have gone for me! Without the knowledge and confidence I had gained with UME, I don’t think I would have known I could file a dispute with the health insurance company and get things figured out. Having had this personal experience, it’s so important to me to spread the word about our resources so that people can get the knowledge and skills they need to avoid situations like this. 

So, if you have ever been confused by health insurance, check out these resources!

  1. Smart Choice, Smart Use – these are workshops focused on different health insurance topics. We have workshops available now and you can register here: https://go.umd.edu/hili_spring_2022
  2. Need to resolve your own health insurance dispute? Check out this resource, it spells out the whole process: https://extension.umd.edu/resource/health-insurance-claim-problem-how-navigate-health-insurance-claims-process
  3. For many other resources, check out https://extension.umd.edu/resource/health-insurance-claim-problem-how-navigate-health-insurance-claims-process

Using Health Insurance in the New Year

Now that we have settled into the New Year, I want you to think about health insurance. If you purchased your insurance from the MarketPlace, your plan year likely began on January 1, 2022. If you have private insurance through the workplace, check with your plan as it may start January 1.

This is important because it resets the clock for your annual deductible and out-of-pocket maximum. The deductible is the amount you owe for services your health insurance plan covers before your health insurance plan begins to pay. The out-of-pocket maximum is the amount you pay during a policy period before your health insurance plan pays 100% for covered services. Deductibles vary by plan and can be a few hundred dollars to thousands of dollars. The out-of-pocket maximum will also vary by plan.

Now that you have health insurance and are paying the premium, you should get the maximum benefit of your plan. Another way to look at it is that you paid for it, you should use it. Just by having health insurance you qualify for free preventive services. A list of preventive health services is available on the Healthcare.gov website.

Once you start using your health insurance you will have co-payments (a fixed amount often found on your insurance card). This is like the $20 (may vary depending on your plan) charge when you visit the health care provider. You may also be responsible for coinsurance (your share of costs calculated as a percentage) depending on the type of service rendered. For example, your plan may indicate you pay 20% and the insurance company pays 80%. Remember that your costs stop at the out-of-pocket maximum.

So let’s go back to the main point, now that you have insurance start using it.

Take full advantage of the health insurance plan and in doing so, it may save you money. Health insurance costs are often something we overlook in our financial planning. The Health Insurance Literacy Team developed a worksheet to help you understand and estimate health care expenses. On our website, you can find information on how to choose a doctor, flexible spending accounts, our workbook, and much more.

Health Insurance and Pregnancy 

Having health insurance during pregnancy is an important part in receiving the appropriate care. This is a time in women’s life where proper care and preventative measures are dire to the health of the mother and unborn child. Health insurance alleviates the burden of medical bills, and it makes it easier to receive check ups and tests. 

Prior to the passage of the Affordable Care Act, not all plans included maternity benefits. This created additional stress for women and families not knowing how to cover maternity expenses. These benefits are now included in the ten essential healthcare benefits. The Affordable Care Act regulated health insurance providers to cover several services received by pregnant women. With a health insurance plan during pregnancy, a woman can attend prenatal visits, participate in routine tests, have access to emergency services, and cover the birth of the child. 

When it comes to choosing a health insurance plan, it’s best to choose what works for you based on your individual situation. Most people are insured through their place of employment. If this is not the case, pregnant women should consider finding an available and affordable plan. Some options include the health care market place (Healthcare.gov), Medicaid, and CHIP (Children’s Health Insurance Program). 

Health insurance coverage during pregnancy is a good way to guarantee the wellbeing of the mother and the child. Anyone considering getting pregnant or who is already pregnant, have options to consider when seeking care. 


This blog written by Family and Consumer Sciences student intern Ashante Scott.

Get The Most Out of Your Health Insurance by Using Your Essential Benefits

Health insurance is not a favorite topic for many people, but there is no denying that it’s important. Especially now, it is important to pay attention to our health insurance policies and make sure that we are using them in the best way we can to stay healthy. 

To stay healthy, you should know what benefits your insurance provides and how to use them.

What are health insurance benefits? 

Under the Affordable Care Act (ACA), all health insurance plans were required to cover ten essential health benefits. These benefits are: 

When you pay your monthly premium, you are paying to make sure you have access to all these services. 

  • Preventive and wellness services 
  • Lab tests
  • Hospitalization
  • Prescription drugs
  • Services and Devices  for injuries, disabilities or chronic conditions
  • Outpatient care
  • Maternity and newborn care
  • Mental and Behavioral Health treatment
  • Pediatric care
  • Emergency room services

How can I use my benefits during COVID-19? 

Although testing for COVID-19 has been provided at no cost to the patient, many people have been using their health insurance to get treated. However, it is important to keep in mind that there are many reasons to use health insurance which are not related to COVID-19! For example, check-ups, vaccines, screenings, and smoking cessation assistance are all covered under preventive care. 

Currently, people may not be accessing these services due to concerns around COVID-19. It can be difficult to figure out if all of the care people require needs to continue during COVID-19, or if it should wait until the care can be provided in a safer way. If you are trying to make a decision about keeping, rescheduling, or cancelling doctors’ appointments, you might find this article helpful. In general, the advice from the article is to stay in contact with your doctor and get their help with deciding what medical care you need and what can wait. 

What does it mean to stay in contact with my doctor? 

Staying in contact with your doctor during COVID-19 can take many forms. Hopefully, you have a primary care doctor. If not, check out this information about how to find one. 

You can stay in contact by calling your doctor’s office — most offices have an option to call and speak with a nurse when you have a medical question. Your doctor’s office may also have a system where patients can send electronic messages to their doctor through a secure system. You can use that system to message your doctor with any questions you might have. Your doctor might advise you to use telehealth services for a virtual visit, come to the office for a regular visit, or even delay your visit until it is not as risky to be seen. 

But the most important thing to keep in mind is that these answers will depend on your health status, age, location, internet connection, and many other factors! There is no one size fits all answer, so staying in contact with your doctor is a must! 

Much of this information comes from the Smart Choice Smart Use program. For more resources, check out our website at https://extension.umd.edu/insure/consumer-resources. You can also learn more by participating in an upcoming training on getting the most out of your insurance by registering at https://go.umd.edu/health_insurance.

Choosing A New Doctor

Doctor suggesting hospital program to patientStarting a new job, moving to a new location, or changing insurance plans can lead you down the path of having to choose a new doctor. Choosing a new health care provider can be stressful, but here are some things to consider:

  • Does new health care provider accept your insurance?
    • One of the most important things to do when searching for a new doctor is making the doctor/provider is considered in-network with your insurance plan. An in-network doctor has contracts with your insurance company to provide services at a lower cost to clients. Most insurance companies will have a website that provides a list of doctor offices that are  compatible with your insurance. If you are not sure, ask a representative from the doctor’s office and they will let you know. In-network doctors are a better option because in most cases, using an out-of-network doctor will cost you more money.
  • Diverse People Listening to the Doctor's PresentationAsk questions, lots of questions.
    • Knowing which doctor to select can be tricky but one good tip is asking people you trust such as co-workers or friends for recommendations. When asking people you trust keep in mind that just because they like the doctor doesn’t mean you will, so it’s best to ask the right questions. Another great tip is using websites such as www.ratemds.com or www.healthgrades.com. You can also interview a potential primary care provider. Call the doctor’s office and be prepared to ask questions to the office staff and the doctor. Asking the right questions can help to make sure that the doctor’s office is a good fit for you. 
  • Know your insurance policy on switching health-care providers.
    • Many of us have had negative experiences with a doctor’s office. It’s best to make sure that you know what your insurance provider’s policies are about switching doctors.  You can find this information in the Evidence of Coverage document. The term sounds technical, but it is just the agreement between you and the insurance company. It provides information of what your plan actually covers, how it works, and what you’re supposed to pay. You can get a copy of this document when you enroll in a new insurance plan, but most insurance companies have a copy on its website.  
  • Call the insurance company.
    • My final piece of advice is when in doubt, call the insurance company.  You should have received a wallet sized insurance card from your insurance company.  Somewhere on the card will be a phone number you can call with any questions. Remember that you are the customer, if you have questions you should be able to get them answered.

If you want more information, visit the Insuring Your Health website.  There is an article that provides greater insight on this topic. 

Cheers to Your Health (Insurance)!

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Welcome to the New Year! 

This is the time we put our past behind us and look ahead toward the future.  Some people set financial goals, while others focus on fitness goals, but I want you to think about health insurance in the New Year.  Thinking about your health insurance insures your well-being and can save you money, so my advice for the new year is to take a fresh look at your plan and follow these five actions to get the most out of your health insurance this year.

Know what your health insurance policy covers.  Whether you selected a new plan for this year or continue with the same plan, know what you policy covers.  In a prior blog, I shared the Essential Health Benefits.  This is a good starting point to reviewing your policy.  You can review the plan’s website or the Evidence of Coverage booklet to find out what is covered in your plan.  

Have proof of insurance at all times.  This is one of those documents you should carry with you.  You will definitely need it when you visit a medical office, but you never know when there will be an emergency.  The health insurance card contains your policy number and contact information, and in some cases, discloses co-payment information.

Choose in-network doctors.  In-network doctors have agreed to offer services at a predetermined price.  Using in-network doctors when possible will save you money. Always ask if the provider is in-network before you receive any services.

Health Laptop Healthcare Wellness Senior Concept

Use preventative services.  These are considered Essential Health Benefits and are often free.  Get your annual check-up and other prevention services such as a flu shot.  Maintaining your health always costs less than delaying health care. For a full list of preventative services visit healthcare.gov.  

Track and organize your health care expenses.  Keeping good records is important.  It allows you to monitor and track your health over time, ensures your medical bills are accurate, provides proof of services you received, prevents medical ID theft, and assists in planning for next year.  Key documents include explanation of benefits forms, receipts, test results, and discharge paperwork. Create a system that works for you and makes documentation easy to find.  

Follow these five steps, and start the year off on the right foot.  More information about health insurance can be found at our Insuring Your Health website.

 

Time for a (Health Insurance) Check-Up

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You have probably heard the expression, “New Year, New Me.” For most people, it is also “New Year, New Deductible.” It’s time for an annual check-up on your health insurance deductible! 

For most of us with health insurance, the plan year ends on December 31.  With the period ending soon, now is the time for some end of year health care financial planning. 

What is a Deductible? 

Your deductible is the amount you owe each year for health care services. It is a payment you make that ensures the coverage of health care services before your health insurance plan begins to pay. Despite this being a part of your health insurance plan, the deductible may not apply to all services.  

For most, the deductible will reset on January 1, 2020, therefore, it’s good to do a little planning which can be a smart financial move. 

What if I haven’t reached my out of pocket maximum?
If you have had enough health care expenses this year to meet your deductible but have not reached your out of pocket maximum for the year, most health care visits will require you to pay a small portion, but not all, of the cost of care. This is the copayment or coinsurance

What if reached my out of pocket maximum?

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If you have already paid your maximum out of pocket costs for the year, most covered care will not cost anything until next year. If you have not yet reached your deductible for the year, and care is not urgent, you may benefit from waiting until the new plan year to schedule visits to your providers. Any costs incurred in the new year will all go toward meeting your new deductible.  

Important points to remember: 

  • First, if you become sick or injured, do not delay treatment.  Postponing care can make you sicker, possibly risk your future, and/or end up costing much more in the long run.  
  • Many preventatives services that help you stay healthier are free!  Check-ups, vaccines, and screenings often cost you nothing so there is no need to delay important preventative care.
  • Health insurance policies vary. Check your own health insurance policy and make sure you are using all of the benefits it provides.

Any care that you need should be scheduled before the end of the year to save you money.  Don’t delay! Providers’ appointment schedules fill up, and getting the care you need helps you stay healthier.  As you begin to create your spending and savings plan for the new year, it is also a good time to reflect on your present health and health costs.  Use this handy guide to assess your health needs and estimate your potential costs for the coming year.

Health Insurance Terms to Know:

Out-of-Pocket Maximum/Limit – The most you pay during a plan year (12 months) before your health insurance or plan begins to pay 100% of the allowed amount.

Copayment – A fixed amount you pay for a covered health care service, usually when you get the service. You may have to meet your deductible first.

Coinsurance – Your part of the costs of a covered health care service. This is a part of the allowed amount for the service. You pay this amount once you have met your deductible. 

Are You Covered? Open Enrollment is Here

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Medical bills and doctor visits can be expensive, but getting covered by health insurance can protect you and your family from the high unexpected costs of treating illnesses, accidents and other unforeseen health problems.

The Health Insurance Marketplace Open Enrollment period to receive coverage or make changes to your existing coverage, is getting close. This year it runs from November 1, 2019, to December 15, 2019.  Concurrently, Medicare Open Enrollment began October 15, 2019, and continues till December 7, 2019. Many employer health plans host an open enrollment period during the same period. 

So what does this mean? That it’s time to think about health insurance and reassess your family’s needs.  

Where can you find assistance?

Each state operates a little differently, therefore it is suggested that you connect with a Navigator or Assistor in that state.  A Navigator or Assistor is someone that specializes in the health field who can help you enroll in a health insurance plan or answer any questions you may have.  Medicare also provides resources if you have questions during the process.  If you have an employer-based plan, contact your Human Resources office for assistance.  

How much will it cost?

The cost of health insurance depends on your income.  Individuals that meet income guidelines can receive tax credits toward health insurance plans on the Marketplace.  A tax credit is money that you receive from the government to assist with paying your health insurance premiums. Premiums are the monthly payments you make to the health insurance company.  

My colleagues at the University of Maryland Extension have several great resources to assist in making health insurance decisions.  Click on any of the following topics for more information.

Choosing Health Insurance Workbook

How to Choose a Doctor

Making a Good Guess on Health Costs

Types of Health Insurance

For a complete list, click here.

Remember that we all need health insurance.  Use it to stay healthy. Routine checkups are an important element in staying healthy and preventing more serious health issues.  In the long run, health insurance will save you money.