Insurance
(Photo courtesy of Freedigitalphotos.net)

By Carrie Victoria

College students were able to start shopping for health insurance on October 1 through Obamacare’s insurance marketplace.

Yet, many are unfamiliar with health insurance and its jargon, as evidenced by a group of nine Mount Saint Mary College seniors who answered four out of 10 health care terms correctly.

“Health insurance is something we need to be educated on,” Nicole Zazzero said.

While many students may continue being covered by their parents’ health insurance, they will have to search and pay for their own insurance at some point.

“I’m on my parents’ insurance right now,” Nicole Armocida said. “I let my dad take care of all that stuff.”

The first step to educating yourself on that “stuff” – learn the jargon.

Being unfamiliar with these terms can be costly, especially when a health care representative begins throwing around the words “premium” and “co-pay.”

CNN and TLC define important health insurance terminology as follows:

1. What is a premium?

A premium is the amount that you pay for your chosen insurance plan.

2. I have to pay out-of-pocket expenses, which is?

An out-of-pocket expense is the amount you pay out of your own pocket for health services that are not considered “covered services” by your health insurance.

3. What about deductibles, co-payments, and co-insurance? What’s the difference?

Before your health insurance starts covering costs, you must pay a deductible. For example, if your deductible is $750, you must pay $750 before your health insurance benefits kick in. If you don’t pay the deductible, you will be paying full costs for health care services.

A co-payment is the flat rate you pay each time you receive medical care or medication. This rate will vary per insurance plan. The health insurance will cover the rest of the costs.

Co-insurance is a percentage of the doctor bill that you must pay. Most of the time this amount is 20 percent. So, if your bill was $100, you would have to pay $20.

4. What is an allowed amount?

The allowed amount is the maximum amount that your insurance company will pay for the health services you receive. There are many names for this – “eligible expense,” “negotiated rate,” or “payment allowance.”

5. And a claim?

A claim is the bill that your doctor sends to your health insurance company.

6. What exactly do they mean by preventive care?

Preventative care is the health care services you receive to keep you healthy. These services can be anything from a regular checkup to a shot.

7 .What is the difference between in-network and out-of-network providers?

In-network providers are contracted by your health insurance company, while out-of-network providers are not.

Why does this matter to you? Because payments to in-network providers will be cheaper than to out-of-network providers.

8. What are the essential health benefits?

Obamacare, or the Affordable Care Act, requires that certain health services must be offered in insurance policies. These services are the essential health benefits.

They include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services, and chronic disease management and pediatric services.

“We aren’t going to be under our parents’ care forever,” Sarah Favata said.

She’s right, and that’s why students need to educate themselves on healthcare insurance right now.

The first step is making sure you understand the jargon mentioned above. Use it to make smart decisions when you start looking for a health insurance plan.