This is a printable version of the Place Corps Guide to Health and Insurance including the Kingston Connections sections.

 

Insurance and healthcare are essential considerations as you become an adult. Healthcare refers to those services you use that are related to your physical and mental well-being that require a certified practitioner such as a general practitioner, a psychiatrist, a gynecologist, and so on.

These services are very expensive in the United States. That is why it is essential for you to secure some form of insurance coverage to help mitigate these costs. 

Insurance:

Insurance is a system in which you pay for coverage by an insurance provider, who will take on part of the costs of healthcare for you. Customers pay an insurance company a monthly premium to be covered. By paying into an insurance provider, you are contributing to the source of money that the insurance provider uses to pay for medical services: sort of like a piggy bank that is shared by the customers of a particular insurer.

There are a number of ways to access insurance: through your employer, through the healthcare marketplace, and through medicaid and medicare. Your employment status, income, assets, and health needs will determine what insurance you are eligible for, and which is best for you. You will find information about how insurance works, different kinds of insurers and insurance plans, terms and language, providers in our region, and more, below.


What is Insurance For?

Insurance is a way to make healthcare more affordable and to give you access to health centers and providers.


How Does Insurance Work?

Insurance works by enabling cost sharing. When you join a healthcare plan, you pay into the insurance company in order to receive benefits from it, namely assistance in covering your medical expenses. The insurance company is able to offset the cost of your medical expenses by using a common pool of money to pay for them. This common pool of money that the many people receiving coverage from the insurance provider have contributed to be a part of it.

It is possible to cost share because many people will not need a significant amount of medical services and their costs will be low most of the time, while some people will need more frequent medical services so their costs will be higher, and everyone may experience moments when their medical expenses increase in such cases as requiring surgery, being injured in a car accident, having a baby, and other life events.


How Much Does Insurance Cost?

Generally health insurance should not cost more than 10% of your annual income. This has increased since 2010 when insurance would generally cost 6% of your annual income. The costs of insurance have grown outsized compared to median income and many households cannot afford to be adequately insured and must instead opt for cheaper plans which are insufficient to meet their actual needs.

Those employees earning lower wages contribute a larger percentage of their income to insurance premiums annually than do those earning higher wages in the same states with households of the same size.
→ 10% of American adults report not having health insurance, mainly due to costs.


What do I need to know in order to understand insurance?

You need to understand the different kinds of insurance coverage there are, and the different kinds of health plans offered by insurers, and understand what your medical needs are and what options you have to access insurance.

Insurance Plans:

There are several kinds of insurance providers and insurance plans, outlined below. The amount that you pay to be insured determines how much of your healthcare costs the insurer covers. Depending on how often you require healthcare it can be better to pay less or more for your insurance plan.

 
 

Insurance Coverage of almost any kind, private or public, is broken down into four categories of coverage which indicate how much the plan costs and how much of your health expenses it covers.

 
 

Health insurance generally covers what are called the ten essential health care benefits:

Outpatient healthcare: this means doctor’s visits and other run of the mill medical services which do not involve hospital stays.

Emergency services: This means your insurance would cover some part of the cost of an ambulance ride and EMS service.

Hospitalization: Your insurance will cover some part of the cost of staying in hospital for treatment, such as in the case of surgery.

Pregnancy, maternity, and new-born care: your insurance will cover some percentage of both the before and after costs of healthcare related to pregnancy, birth, and infant and new mother care.

Mental health and substance abuse: your insurance will cover some percentage of expenses related to mental health and substance abuse services, including prescriptions, counseling and therapy.

Prescriptions: your insurance will cover some percentage of the cost for prescription drugs and other behind the counter medical treatments.

Rehab and habilitative services and devices: your insurance will cover some part of the cost of services and tools for people with disabilities, injuries, or chronic conditions to help recover mental and physical capacities.

Laboratory services: your insurance will cover some percentage of the costs for lab work, meaning those tests your doctor runs to see if you have strep, Lyme disease and other ailments.

Preventative and wellness services: Your insurance will cover some percentage of these costs which include such services as shots, medical screenings, sight and vision checks, etc.

Pediatric Services: your insurance will cover some percentage of the costs for adolescent medical care including vision and dental care, even though these are not considered essential health benefits for adults.

Insurance Networks: In-Network vs. Out of Network:

An In-network practitioner is a doctor or medical professional who is within your insurance coverage. This means that they will be more affordable.

An Out-of-Network practitioner is a doctor or medical professional who is outside of your insurance coverage. This means they will be more expensive, your insurance provider may not provide any compensation for these practitioners, or a small amount.