MSU Extension 4-H Adulting 101

Welcome, everyone to MSU Extension's Adulting 101 program. Adulting 101 is offered monthly on a variety of topics. Each session is packed full of important life skills and tools necessary to successfully live independently. We are super excited to offer Intro to Medical Insurance as part of our Adulting 101 program. Thanks to our presenter, Melissa Richardson, who is also a 4-H volunteer, super excited about that. Melissa works as an account management executive at Marsh McClellan agency, and that's in Troy, Michigan. So she has worked in employee benefits and medical insurance for over 20 years. So she has lots of knowledge in this area. She's also the proud mother of two Michigan State Spartans, and she has agreed to record this session, so we will be able to post it later for those who are not able to join us today. So we're super excited to have her. If you want to go to the next slide. (It's not letting me, Kathy.) (It's not letting you? No, that's weird.) Oh, there we go. Sorry. That's okay. So MSU Extension believes fully in our principles of diversity, equity, and inclusion, and we know that human differences enrich our lives, our work, and our community, and we embrace our responsibility to be a resource for all and are committed to providing programs to all segments of our community. So with that in mind, I'm going to turn it over to Melissa so she can begin her presentation. Thank you. Thank you, Kathy. I appreciate the warm welcome. As Kathy mentioned, my name's Melissa. I work at Marsh McLennan agency. Marsh McLennan is a consulting and insurance brokerage firm. I'm super excited to be here, as Kathy mentioned. But more importantly, I am happy that you are here. I am very, very passionate about benefit education, and having worked a long time in this field, I can tell you I get it. This is a confusing topic. And so I'm so excited that you're all here tonight so that we can try and demystify a little bit of this subject. So, before we get started, I really wanted to start with some positives of medical insurance because I feel like it is a confusing topic. There's a lot of confusion around it. And so sometimes there's a lot of negativity, and I wanted to just start with just a few positives of why you might even want medical insurance because you may be sitting out there young and healthy and wonder, gosh, why do I even want this? So let's start with a few things. The biggest thing really on why you would want medical insurance is that it really can give you financial protection in case you do have a serious illness or injury. And again, you might be young and healthy right now, but anybody could get hit by a car tomorrow through no fault of your own and incur a really large amount of medical expenses. So you know, like I said, working in health care a lot, I see a lot of these healthcare claims. I know how expensive it can be. And so if you did have something catastrophic or major happen, you would really need the financial protection that medical insurance can give you to help you pay for those bills. Another positive feature about medical insurance is it can help keep you healthy because it can connect you to a regular source of care. A lot of medical plans out there will either require you to name a primary care physician or at least encourage you to name a primary care physician, that'll help you maybe get in front of a doctor at least once a year to just talk about your health, see what's going on, and perhaps get ahead of any medical condition that you might have brewing that maybe you didn't know anything about. And finally, it can just give you peace of mind about financial and health concerns. You know, we all have to be able to put our head on the pillow at the end of the night and know that we've got protection. So medical insurance can help you with both financial and health concerns that you might have. But again, I'm going to tell you, I totally get that this is not easy. They don't make it very easy at all. Medical insurance is confusing. Oftentimes, people don't even know where to start. There's a lot of rules and terms. It's almost like you're speaking a different language. So there's a lot of things to understand. It can be very complicated, especially when you're new to medical insurance and maybe you have different plan options and you have to pick one. It can be complicated and you don't even know where to start. And then finally, to top everything off, it's expensive. And there's a lot of people out there who think, gosh, not only is this hard to understand, a difficult system to navigate, but I don't even want it anyway. And now it costs a lot of money on top of everything. So I hear you. I totally understand that this is a very you know, hard thing to understand, and it's a hard system to navigate. And that's really why we put together this presentation tonight because we wanted to just try and help in any way we can. And so, tonight, during this webinar, we're going to go over some common terms and concepts. We're going to talk about real life examples with medical insurance. We're going to provide what I hope is some helpful takeaways, and then we'll go over some frequently asked questions. So I'm going to throw a lot at you tonight. Stay with me. I'll try and make it as fun as possible. Kathy's put together some great poll questions. So we're going to stop and take a break here and there. And we also have a video to watch. So just hang in there, and we'll get through this together. So getting started, let's start talking about medical coverage. Medical coverage can be offered with many different plan designs, and these plans can vary in coverage and cost. So as you're looking at medical plan options, just know that all of them are going to be structured, generally speaking with these parameters, deductibles, co pays, co-insurance, and out of pocket maximums. Now, a very common plan design is something like you see here on this slide. Maybe $1,000 single deductible or 2000 for family. You would have co-pays that vary in amount depending on the service. For example, you might have a $30 co-pay for a primary office visit, maybe $50 for urgent care. There would be a 20% co insurance and perhaps an out of pocket maximum of either 4,000 for single or 8,000 for family. We are now going to dive into what each one of those topics really means into more detail. And we're going to start with deductible. So you may have already heard this term before, because a deductible can also be found in things like auto insurance or home insurance. But essentially, a deductible is the amount of money that you have to pay before the medical insurance will pay for certain covered services. For example, your plan might have $1,000 single or $2,000 family deductible. This means that for services where a deductible applies, a single person would be subject to $1,000 in expenses. And a family, which would be generally two or more people on a contract would be subject to $2,000 in expenses before the insurance company will pay any amount. Now, deductibles can range from low to high. So when you're looking at medical plans, you'll see a very wide range of deductibles. I'm here to tell you that, generally speaking, if you have a plan with a low deductible, it's going to cost you more in premium. And premium would be the amount that you're paying out of pocket just to have the coverage. And maybe you're paying your premium through a payroll deduction if you have an employer health plan, or maybe you're actually paying that amount to your insurance company every month as a monthly bill. Either way, when you're paying premium, if you have a plan with a low deductible, you're generally going to pay a higher premium. But conversely, if you have a plan with a very high deductible, then you're, generally speaking, going to pay lower in premium. And I'm going to tell you that there's really no right or wrong answer. I get asked all the time. Which plan should I pick? Which plan is the best? And, honestly, when it comes to deductibles, it's sort of a game of risk and what you feel comfortable with. There are some people who feel like, Hey, I don't want to put a lot of money out of pocket on the front end. For something that I might never use later. So I'll just go ahead and pay less now and then know if I really have a lot of claims and I have to use my coverage, I'll have a higher deductible. I'm okay with that. But there's other people who feel like, No, I'm willing to pay more now. That gives me comfort. I feel better about that. And then I know if I have to use the coverage later, I'm going to pay less out of pocket. So, like I said, neither one's right or wrong. It's just something you should know going into this as you evaluate plans. So going back to things to know about a deductible. Once your deductible has been met, co-insurance typically then applies to covered services, and we're going to talk a little bit more about the co-insurance later. Continuing on with deductibles, you should know that deductibles do not apply to all services. There are some things covered on your plan where you don't have to pay that deductible cost. And the biggest thing is preventive care. You may be familiar with ACA. It was passed about gosh, over ten years ago. And part of ACA said that preventive care would be covered at 100%. So things like annual exams, immunizations, routine tests, covered at 100%, no deductible, no other cost share. And then also sometimes your plan will cover things with just a flat dollar co-pay. So sometimes you have, like an office visit or a prescription or you go to urgent care, where all you have to do is pay a flat dollar co-pay amount, and that's it. So there's no deductible expense associated with that, either. So just know, when you look at that deductible, not everything is going to apply to it. The other thing to know about deductibles is they do typically renew every calendar year, not always, but most plans are set up to run January 1 through December 31. So what that means is every January, your deductible is going to reset, and you're going to end up paying those expenses out of pocket until as the year goes on, you slowly chip away and meet your deductible. And then the last thing to know is we talked a little bit about this earlier, but most deductibles are listed as single-family. So that means if it's just you on the contract, you would pay the single amount that's listed on the deductible. But if you have two or more members, then you're most likely into a family contract, and then you're subject to the family deductible. So now we'll move on to co-insurance. Co-insurance applies once your deductible has been met. And what this means is at this point, once you've met your deductible, the insurance company then pays for the majority of the cost, and you pay a remaining portion. And this sharing of expenses is called co-insurance. And normally co-insurance is calculated by a fixed percentage of the covered expense. So you may have been looking at a plan and heard somebody say, Oh, it's 80/20 or oh, it's 70/30 after I've met my deductible. What they're referring to is that the insurance company would pay 70%, maybe 80%. You would be responsible for the remaining 20% or 30%. So as an example, if your plan has a deductible of $1,000 and you have co-insurance of 20%, you pay the first thousand, and then you pay 20% of the allowable charges after that with the insurance company picking up 80%. Now, co-insurance amounts can vary by service, and sometimes they're even zero. So sometimes you'll have something on your plan where once you've met your deductible, there's no more co-insurance, and the insurance company pays for it at 100%. And also, the other thing to keep in mind is sometimes there's caps that are applied to co-insurance. It's sort of a safety valve, if you will. And what this means is that you only have to pay up to a certain amount in that percentage, that 20%, that 30%. And then once you reach that certain amount, the insurance company takes over and starts paying 100%. The next term I wanted to review with you is co-pays. Co-pays are flat dollar amounts that you pay for the cost of a covered service. Co-pays are typically applied for things like prescription drugs, office visit, urgent care visit, sometimes physical therapy, sometimes chiropractic. Those are generally the things where you might see a co-pay is applied. Now, co-pays are usually due at the time of service. They're usually paid directly to the provider. So, you know, you might be at your doctor's office and maybe you're checking out, and they'll tell you, Oh, we ran your insurance, and you have a $30 co-pay. You're like, Okay, you pay your $30, and guess what? You're done. There's no more cost share. You don't have to file a claim. It's quick. It's easy. So co-pays are great. They don't apply to all services, as I mentioned. There's usually just select categories of services where they apply. So you're not going to see a co-pay on everything. So again, really important to get to know your plan so you know where you're paying a co-pay and where you're paying deductible and maybe co-insurance. Last term I wanted to go over with you is an out of pocket maximum. The out of pocket maximum is the amount on your medical plan that reflects the maximum amount you would have to pay for covered services during the benefit year. This is such an important figure to understand. It's a combination of three things. It's a combination of your deductible, plus your co-insurance, plus co-pays. This was another nice safety valve that went in with the ACA, basically what it says is, Hey, we understand that we need to put a cap or a limit on how much any one person can pay out of pocket. Because before ACA went in, there was no out of pocket maximum. It was unlimited. And so it was incredible to think about the amounts that people might end up paying out of pocket. So nice feature about ACA is they put in out of pocket maximum. So every single medical plan out there has this. And to me, it's just a really important feature to look at because it tells you your worst case scenario. If you ended up using all kinds of services throughout the year, maybe you had a major accident, major illness, it tells you, Okay, the bucks going to stop here. Once I've reached a certain amount, I'm done. I don't have any more cost share. So again, just to regroup on what this is, it's a combination of deductible, plus co-insurance, plus co-pays. I like to think of it as, like, one bucket. So one bucket of expenses. So anytime you're paying out of pocket, it's going into that bucket. Some facts to know about out of pocket maximums. Again, it sort of tells you, worst case scenario, how much you'd have to pay. So me personally, when I'm evaluating a medical plan, my eyes always go to that out of pocket maximum amount, and I always stop and ask myself, Okay, if I had to, could I pay this amount? If something happened to me tomorrow, would I be able to cover this amount? So when you're looking at medical plan expenses or excuse me, medical plans, and you're trying to decide which one to pick, always look at that out of pocket maximum. It's just an important number to understand. And then sort of similar to our discussion about deductibles. Another thing I'll tell you about plan design is that generally, if you have a higher out of pocket maximum, you're going to have a lower cost on the plan. So what you're going to pay in premium. So again, no right or wrong answer here, but I'm going to tell you that if you're more comfortable with a higher out of pocket expense, then you're going to pay lower on the front end for premium. Just like conversely, if you just don't have that comfort level and it makes you a little nervous, you can pay more on the front end in your premium and then have a lower out of pocket maximum when you actually use the coverage. Now, the cool thing about out of pocket maximums is that if you do hit this amount in any given plan year, the insurance company takes over after that point and pays 100% of all covered expenses for the remaining portion of the plan year. So again, nice feature. Make sure you really look at it when you're reviewing plan design because it's just a really important thing to know. And I'm going to pause here for a minute, and I'm going to turn it over to Kathy, and she has a poll question for you all. So I'm going to launch the question, and as you can see on the screen, that's the question and I'll read it in case you can't see it. Rob receives a bill for the full cost of his CT scan. The scan is a covered service, and Rob went to an in network facility. It is early in the plan year and Rob has not had many medical claims so far. What is Rob most likely paying? Is he paying costs towards his deductible, cost towards his co-insurance or costs towards his co-pay. What do you think? I'm going to give you a moment. We're testing your knowledge here. Because Melissa went over all three of these terms. I'm going to give you about five more seconds if you want to participate and then we'll share. Okay. We got about 67%, 69% participated. So I'm going to end the poll. So we had the majority of you said cost towards his deductible. Yay. Yay, right? That's the correct one. 79% of you. So awesome. That's great. And I have another little poll to test your knowledge a little bit further. So I'm going to stop sharing this one and I'm going to do another one, for the next slide. Okay. So let me come back. Whoops. So this one is I'm going to launch this one. So true or false. So it's an easier easier question. So Val goes to her pharmacy and is charged $15 for her prescription. She pays the amount and there is no claim to file or other charges to pay. Vale's $15 charge is a co-pay. Is that true or is that false? They're coming in fast. I'm going to give you another couple of seconds here. See if we can beat the participation. We beat the participation. We're at over 72% 74%, so I'm going to end the poll. 85% of you said it's true. That's awesome because that is true. Way to go. Yes. Yes. Nice job everyone. I know, right? Yay. Very happy. Alright, thanks, Kathy. So now we're going to move on to another part of our presentation where I'm going to try and help you to understand this in real life, because I totally get that talking about this, you know, it's a lot. These terms are kind of boring. But if you apply it to a real life situation, maybe it'll help a little bit. So I put together this example, and I kind of made this up, but meet Paige. And I'm going to tell you, Paige is single. She's enrolled in medical insurance. She has a calendar year plan design. And this is how her plan is structured. She has $1,000 single deductible. And remember, I started out by saying she's single so we know that that's gonna be her deductible for the year, $1,000. She has co-pays on her plan, such as a $30 primary office visit co-pay. She's got a $50 urgent care co-pay. She has 20% co-insurance, and she has an out of pocket maximum of $4,000. So let's walk through an example. If you look at this chart that I put together, you'll see that I have different columns set up. First is the date of service, and then I have the service provided, the cost, and by cost, I mean, the total cost for whatever it was that she had done. And then I put together two columns. So column that says what paige pays, and then a column for what the insurance company pays. We're just going to walk through this. So let's say it's January. Paige is feeling great. It's a new plan year. She's like, You know what? I'm going to take really good care of myself this year. I remember that I've got preventative care that's covered at 100%, no cost, so I'm going to go in and get an annual checkup. Yay, awesome. So she goes, It's a $90 charge. But if you look in that column for Paige pays, you'll see $0 because, yes, it's considered preventative care. It was covered at 100%. She has no co-pay. Nothing is applied to her deductible. And then if you go to the far right, you'll see the insurance company paid the full $90. So, great. Move it along. It's March. Paige isn't feeling good. She thinks she has a sinus infection. So she decides to make an appointment with her primary care doctor. The cost of that office visit is $110. However, remember, Paige has a $30 primary office visit co-pay. So out of her pocket is $30. The deductible does not apply. It's a flat dollar co-pay. So she just pays her $30. That's it. And then you'll see that the insurance company picks up the difference of $80. April comes. Paige has an issue. She ends up in the ER, the emergency room. The cost is $3,500. Wow, that's a big one. Because that bill is so high, you'll see that Paige had to pay the first $1,000 because she had not yet met her deductible, and that's a pretty big claim. So Paige had to pay the first $1,000. And then, in addition to that, her plan was set up where it had a $250 emergency room co-pay. So out of Paige's pocket was $1,250. And the insurance company picked up the difference of 2,250. Then May comes and Paige has a sore throat. So she ends up back at her doctor's office. Excuse me, back to urgent care because it's the weekend and her primary care doctor is not open, and her throat is killing her. And she's pretty sure it's strep throat, and she needs an antibiotic. So she finds herself in urgent care on a Saturday afternoon, she has a flat dollar urgent care co-pay of $50. So you'll see that while the charge was 160, she paid $50. It did not go towards deductible. It was just a flat dollar co-pay. The insurance company picked up the rest. Sure enough, she did have strep throat. She needed an antibiotic. The doctor prescribed this for her. Thankfully, it was a generic drug. So she had the generic drug co-pay applied, which was $10, and the insurance company picked up the rest. Again, deductible doesn't apply. It was a flat dollar co-pay. Uh, August comes. Paige's allergies are just driving her nuts. She's got asthma. She thinks the allergies are just out of control. So she wants to see her allergist. Well, an allergist is considered a specialist. And sometimes, on different plans, you'll find that the office visit co-pay is different for either a primary doctor or a specialist. On Paige's plan, it's $50 to see a specialist, not 30, like she was paying for her other office visits. So she pays $50 for her specialist office visit. And, again, the insurance company picks up the rest. Deductible does not apply. September comes. She's got a really sore wrist. She thinks that she really screwed it up. She fell when she was out. So she ends up going to her primary doctor to talk about the wrist. She pays $30 for her office visit. Again, primary office visit co pay. But, guess what? This doctor says, You know what? I think it might be broken. We're gonna need to do an Xray. Well, the thing about Paige's plan is X rays are subject to deductible and co-insurance. But at least the good news here is that Paige has already met her deductible. So she just simply has to pay the 20% co-insurance. 'Cause remember, she has $1,000 deductible, but she met it when she was at the ER earlier in the year. So now that her deductibles been met, she just has to pay 20% of covered services. So she pays the $120 from the total charge of $600. And the insurance company picks up the rest. Whoops. Sorry. Hang on. Is there ever any plans that don't have co-pays? Um, yeah. Yes. Yes, they do. Okay. Yeah. Generally speaking, most plans have co-pays of some kind, but yeah, there can be a few. So okay, sorry about that. Getting back to the example. So they did that X ray, and they found out, sure enough, Paige broke her wrist. So now she's looking at surgery. She's got an inpatient admission. The cost is $6,000. Um, thankfully, out of that $6,000, because her deductibles been met, she only has to pay the 20%, and I'm not trying to make light of it. I know that's still a lot of money. But thank goodness she at least had insurance because if not, you know, 6 grand is a lot of money. But Paige, because she met her deductible, pays the 20% of the 6,000, which is 1,200, and the insurance company picks up the rest. Then throughout October and November, Paige ends up in physical therapy. She needs to do some rehab for her wrist. On Paige's plan, she has co-pays for physical therapy where it's $50 per visit. So she has to pay $50 for all eight visits, which ends up being $400 out of pocket. And then I threw in another line here just to make sure that, um we added a few more expenses so that you could see how things are covered. Throughout the whole year, Paige was seeing her therapist, and she was doing online therapy. And the way her plan is designed is she has a $50 co-pay for a specialist for online therapy. So because she went 15 times throughout the year at $50 each, she also paid $750 out of pocket for the therapy. Now, let's look at some of these totals. So far, up to this point in the year, you can see that her total medical charges that were billed by doctors, hospitals, her therapist, any other medical provider she saw was $14,600. Out of that amount, her insurance company paid 10,710. Again, another reason I'm just pointing out here why you would want insurance, right? Now, out of those expenses, Paige paid 3,890 out of her own pocket. Out of pocket. Does that term sound just a little bit familiar? I'm hoping it does, and I want to review with you. Remember on her plan, Paige has an out of pocket maximum of 4,000. So if you see where I'm going with this, she's really close to that 4,000, right? She has spent $3,890 out of her own pocket once you add up her deductibles, her co-pays, her 20% co-insurance. So what do you think would happen now if she had more claims? Well, let's throw another example in, and I'll tell you. So, sure enough, her doctor wants to do a follow up Xray because now that she's had surgery on her wrist, she's gone through physical therapy, the doctor's like, Alright, we're gonna do another Xray just to make sure your wrist really healed. Well, Xrays aren't cheap. $600. She'd already met her deductible, so thankfully, she would only be paying 20%, but guess what? Once that 20% sort of was getting applied to her charges, she reached that $4,000 magical number. So she capped out. She paid $110 to get her to the four grand, and then she's done. She does not have to pay anything more in cost share the rest of the year. So while it's never good to incur a lot of medical expenses, and I wouldn't wish that on any of you, it is kind of a nice feature about a plan when you do hit that out of pocket maximum. Because then that does mean for the rest of the year, your covered services are covered 100% by your insurance company. So just wanted to point out again that that's a really important figure to look at. So I hope that helped a little bit, as we explained, you know, how it would work in real life. Before we go on, I do want to point out that this did not count premiums. Correct. Yes. Good point. Good point. Yes. So what Kathy's trying to point out is like, Hey, you're paying money out of either your paycheck or you're sending money to the insurance company every month just to have the coverage. And unfortunately, those premium amounts don't go towards that out of pocket maximum. So yeah, thank you for pointing that out, Kathy. So before we go on one more time, 'cause somebody had a question in the Q&A that I was trying to ask about the co-pays. Like, some insurance companies don't they don't provide the co-pays. So then would all of those expenses be coming out of the deductible then? Sometimes. Yep. Yep, especially if you're on a high deductible plan. What you would see is very, very few co-pays, if any, and instead, all expenses apply to deductible. Okay. So, yep, yep. It all depends on the plan design, but, yes, that can for sure happen. Do you want me to share? Um, whatever you think is best. Okay, I'm going to share so we can watch this. Let me see. I can't click that button either, so Okay, we got a short little video for you that's gonna help explain a couple of differences between HMOs and PPOs. And I think it covered some of the terms again, so another refresher for you. Healthcare plans to look. The two most common are an HMO and a PPO. Let's talk through some of the differences. So what is an HMO? HMO stands for health maintenance organization, and it's generally your cheapest health insurance option. Typically, your HMO will have low premiums and low deductibles and fixed co-pays. One limitation of an HMO is that you're required to choose a PCP from their network, and you won't be able to see a specialist without a referral from that PCP. If you don't have significant medical issues, and your budget is tight, which is a familiar situation for a lot of young Americans, an HMO might be the right idea. A PPO is generally the best quality plan in terms of benefits because you can see specialists and out of network doctors without a referral. But these are also the most expensive in terms of your premiums. If you envision yourself needing a lot of medical care and you can't afford these higher premiums, then this is a good choice for you. Two less common types of plans are POSs and EPOs. A POS A POS or point of service plan is similar to an HMO in that you need a PCP to refer you to a specialist, but the plan does cover out of network doctors unlike an HMO. EPO is not a common type of plan, but you'll see it around. They generally have larger networks but operate like an HMO in that they cover only in network care. HMO, EPO, EPO, POS, say that five times fast. HMO PPO, EPO HMO PPO, EPO, HMO PPO PTO HMO PPO, EPO POS That's so much to ask. Now let's quickly cover two more types of insurance plans that you may. HSAs or health savings accounts and FSAs, flexible savings accounts are tax free accounts that you can pay into to help cover medical expenses as they arise over the course of the year. You can use money you've set aside to cover co-pays, prescriptions, and some medical equipment. So be sure to look at the options available to you from your employer because it can be nice to have some money set aside every year that's not taxed for your medical bills. Overall, you have multiple options to choose from. What you select will generally depend on your medical needs. Later, we're going to discuss how to think about your health insurance options. Let's stay tuned. Thanks for watching this lesson. If you enjoy it, then please subscribe Okay. I'm going to stop sharing. So there was a couple of questions in the chat. So somebody mentioned premium. What is a premium? So the premium is the amount that you pay every month for your health insurance to begin with. Is that how you would describe that? Yeah. That's exactly it. Okay. Yep. And if you have a job through excuse me, if you have health coverage through your job, through your employer, oftentimes you pay your premium through your paycheck. So they're pulling it right out of your pay on a pre tax basis, usually. But if not, if you're buying your coverage, like through maybe a marketplace exchange or some other way, you might be mailing it or having it auto deducted out of your bank account to an insurance company every month. Yeah. Yeah. Alright, so moving on, we're now going to transition into just defining and telling you more medical insurance terms that might be helpful for you to know. And you've heard me throwing some of these around. So some of this might sound a little familiar, but let's dive right in. First of all, a PCP. A PCP stands for primary care physician. PCPs can manage a wide variety of healthcare needs, such as routine preventative care, but also treatment for injuries and illnesses. Examples of PCPs are like general doctors, family practitioners, an internist, a pediatrician, that sort of thing. An HMO stands for a health maintenance organization, and this is the type of medical plan that usually comes with lower premiums. However, the thing to know about HMOs, and he just talked about it in the video is that they do require you to name a PCP, again, a primary care physician that coordinates all of your medical care, and you have to see that doctor for all of your care. Essentially, if you do not see that PCP and you see a doctor outside of your PCP for care, you don't have coverage. So unless it's like a life threatening emergency, you generally do not have coverage. So it's really important if you're in an HMO plan to understand how it works. You do have to name a PCP, and you have to stay within that PCP, and they're the ones that direct and drive all of your care. Now, if you go to your PCP for an issue and your PCP says, Yeah, I'm not qualified. I can't deal with this. You need a specialist. That's fine, but you have to get the referral from them to then go on and see that specialist. You can't just go directly to the specialist. Now, a PPO is a different kind of plan than an HMO. A PPO stands for a preferred provider organization. A PPO plan generally comes with a higher premium. However, the nice thing about a PPO is it does give you the flexibility to see any provider you like, and you don't have to name one doctor as your primary care physician. So in a PPO plan, you can go in Network or out of Network and still have coverage. Now, for some people, they don't really care who they see. So an HMO makes a lot of sense. They're fine and comfortable with the doctors within the network. They like the idea of not paying as much out of their pocket in premium. So HMO, great. Other people are really locked into having choice, having the flexibility, and so they really find that the paying more money for a PPO is worth it to them. So again, not a right or wrong answer, but you just need to understand when you're looking at medical plans, what kind of plan you're looking at, HMO PPO. Moving on, network. A Network is a list of providers that you can see for care. Doctors, hospitals, other medical personnel who contract with an insurance company are all considered in network, and those that choose not to contract with the insurance company are considered out of network. You are always going to pay more money if you go out of network. So it's always a great idea if you can to use in network providers because it saves you more money in the long run. Another term HSA stands for health savings account, and an FSA stands for a flexible spending account. Two very different things. However, they are both similar in that they're both savings accounts where you can put money aside into the accounts usually on a tax free basis to then use for unreimbursed medical expenses. So things like your deductible, your co-pays, even dental and vision expenses. The whole catch is that the money is coming out of your paycheck before your taxes are calculated, so it reduces your taxable income. So let me give you an example. Let's say you make $30,000 a year in your job. If you take $2,000 and you set it aside in an HSA or an FSA, now you're only paying taxes on $28,000 per year. So it's reducing your taxable income. If you're not paying taxes on $2,000 a year, it would depend on your tax bracket, but you might be looking at, like, $400 in savings right there. So that's the whole catch. So, you know, people ask me all the time, why would I want to do an HSA or an FSA? It's my money coming out of my paycheck, going into this account, and then it's a reimbursement account. I'm just submitting a claim and getting my money back. Why do I want to do this? The whole catch is the pre tax savings. You are reducing your taxable income, so you're not paying taxes on the the amount of money that you pay every year in income. There are a lot of rules because anytime you're talking about pre tax savings, the IRS is involved. So there are a lot of rules to know about these accounts. So I think they're great, particularly HSAs. I'm a huge fan. That would be a whole another topic if we talked about HSAs. I think they're great, but you really do have to do your homework. You really do need to read through the rules and understand how they work before you sign up for it. And I think we have another poll. We do. That's your knowledge again. Now, this one's tricky because it's got two questions all in one. So let me launch the last poll of the day here. So the first question we have is Alex's new medical plan requires him to name a PCP. What does this mean? Does it mean that A- Alex must pick a geographic area, both county and state in which he will use his medical coverage? B- Alex must pick a doctor that will become his primary doctor for all of his care. C- Alex must pick a hospital network to use for all of his care. And then the second question is, Alex is most likely enrolled in A if he has to choose a PCP. Is that an HMO plan or a PPO plan? One or two. So there's two questions in this. So I'll give you a little extra time to answer both of them... Hey, we got about 57%. Looking for a few more. This one's a little harder, I think. It is... Okay, I'm gonna give you about five more seconds. Five, four, three, two, one. I'm going to end the poll. They did well though. B, a PCP. Primary care physician is what that stands for, as Melissa indicated. The second question, Alex is most likely enrolled in an HMO because he has a primary care physician. Whereas the PPO, the preferred provider organization, you don't necessarily have to have one. Um, oh, let me share the results. Sorry. So you can see where everybody's at. But you did great. We got 87%, got the right one, and then another 78% on the second one. So, nice job. Way to go. Yay, yes, that's awesome, everyone. This is tricky stuff. It's hard. It is. It is. It really, really is. Like I said, it's like learning a whole other language. All right. So moving on, I put together a few what I hope are helpful takeaways. Like I said, I've worked in health insurance a really long time. Sometimes I hear, like, the same questions and the same things come up again and again. So I decided to just put together some things some tips and tricks and talk about frequently asked questions. So the first thing I'll tell you is you really, really do have to do your research and find your plan material. And I know that's hard. It's not always easy to find this, but every medical plan has, like, a benefit summary where it basically tells you how things are covered on your plan. So in this example here, like I'm telling you, oh, labs and Xrays. Those are covered, subject to deductible and co-insurance. So that means, I know if I have lab work done, I'm going to have to pay the amount up until my deductible, and then after that amount, I'm going to have co-insurance. And then that same document might tell you that you have either a 30 or $50 co-pay for a primary or a specialist office visit. Or you might have a 15, 30 or $45 co-pay for your prescription drugs, either generic brand name or specialty. So you'll want to get your hands on this document if you can, because it really will help you understand how things are covered on your plan. Now, another important thing to know is that only covered expenses are paid by insurance companies. And if you've been listening carefully to me tonight, you'll notice I have said covered services and covered expenses throughout the entire presentation. And I did that with a lot of intention because I really wanted you to understand that not everything is covered. And that's one of the most frustrating things about health insurance is you think, Okay, I'm paying all this money every month to have this coverage. I should at least be there for me when I need it. But insurance companies at the end of the day are a business. They have parameters. They have contracts, and not everything that you think might be covered is covered. So it is really important that you read through, like, again, that benefit plan material. There's always going to be a list of exclusions listed in that material. And I'll tell you, some of the most common ones I see are, like for cosmetic or elective services. So things like Botox and cheek and brow lifts or cosmetic dentistry. Anything like that is never a covered benefit. Most of the time, what you're going to see is it needs to be medical necessity. So just something to keep in mind as you're looking at your plan design. And then always ask yourself, Oh, does my medical plan require me to name a PCP? Because remember, if you do, you're probably in an HMO, and you have to remember to see that doctor when you need care. You can't sign up for an HMO, not see your doctor for a year, and then go, Oh, well, I'll just go to, you know, blah, blah, blah, down the street, just completely forgetting you had an HMO plan, and you got to see that primary care physician that you signed up for. So really, really important that if you're required to name a PCP, that's where you go for care. Another thing to keep in mind is we talked about this early on. Not all expenses are applied to the deductible. There are some things that sit outside of the deductible. For instance, that preventative care, as I talked about earlier, where it's covered 100% with no cost share. And then here's the point Kathy brought up earlier, which is such a good point. Out of pocket maximums, they don't include everything. So the premium that you pay to have the coverage does not go towards that out of pocket maximum. Balance bill charges, that's when you go out of network, or bill charges for non covered services also do not go towards that out of pocket maximum. So if you remember, I talked about that bucket, and I talked about three things that feed into that bucket for out of pocket expenses, deductible, co- insurance, co-pays, only those three things, so nothing else. Now, here's a question I hear a lot. How can I learn more about my medical insurance once I'm enrolled? What I'm going to tell you is when you sign up when you newly sign up for health insurance, most likely, they are going to mail you an ID card, and they're gonna probably give you some information about where you can go online and create a member account. So every insurance company out there has this ability where you can go to their website, create a member account, or you can download their mobile app. And I highly encourage you to do this because once you get that online account or that mobile app, you're going to have all your plan information right there. So the thing I talked about earlier, like the plan benefit summary where you want to see how things are covered, that would all be in your member portal. If you want to know, like, Oh, do I have chiropractic coverage? Do I have coverage for physical therapy? Do I have mental health coverage? All of those things you can find in your member portal or on the app really, really easily. So I'm going to highly encourage you the first thing you should do when you get new insurance. The other thing that's super helpful about the member portal or the app is that you can look at your claims. So any claim that's been submitted to the insurance company, you will be able to see it listed there, and you can see how that claim was processed. Now, if you've done your homework and you know, like, Oh, why did I get charged that? Because I should just have a 20% co-insurance. I think maybe this was processed wrong or I think maybe I'm getting billed wrong. That's where you can find out this information. Because let's face it, every one of us has gotten a bill from a doctor's office or a hospital or a lab, and you don't know what it is, and you're expected to pay it. And sometimes, if you don't pay it, you get really scary notices about how you're being sent to collections. So when you get those bills, you have to take them seriously, and sure enough, it may be something that you're responsible for. It may be something that was applied to your deductible or your 20% co-insurance. It very well may be a legitimate charge that you have to pay for. But the key here is that you need to reconcile it with what you're seeing with the insurance company. You need to look at your claims on the app or the member portal. Make sure, number one, they got the claim. Make sure the insurance company received the claim and that it was processed. And then, number two, review it. See how it was processed. Make sure it was processed correct, based on your benefit plan terms, and then make sure you were billed properly. So if your insurance company says you're responsible for $50 and you've looked it over and that looks correct, make sure you're actually getting billed for $50, and that's what you're paying. I will tell you, I see mistakes all the time with medical bills. So this is a really, really important step. Don't just blindly pay those bills, really get into them, and check them out. And then the other thing I'll tell you just because I love to save money is that oftentimes these insurance companies have member perks, where just by virtue of being a member with Blue Cross Blue Shield or Cigna or UHC or whoever it is, they give you these really nice perks, things like discounts on gym memberships or fitness gear or recreation or meal kit services. And then they also oftentimes have these digital resources that can be really helpful. So if you're trying to lose weight or quit smoking, or maybe you have diabetes and you're trying to manage it better. They have all these digital tools that can help you with that. So definitely poke around that app. Check it out. There's a lot of really nice things on there. And then here's just one other thing I'll mention. For Blue Cross Blue Shield and Michigan, in particular, their Blue 365 member perk area changes like every few months, and it's unique for you based on where you live. So when you're creating your member portal or your account, it has your address. It knows where you live, and it's going to pull up discounts and all these really great programs specifically for your area. So, again, next time you're standing in line or just sitting around on the couch at night, scroll through that member perks because you'll be amazed at the things that you can find in there. So next thing I hear a lot is like, Okay, how do I use my coverage? I don't understand this. So as I mentioned earlier, you're most likely going to be mailed an ID card. Although I'll tell you, just last week, I read how Cigna is no longer mailing ID cards. They're doing it all virtual now. So maybe when I say you're going to be mailed an ID card, that's not going to be true as we move forward in our new virtual world. But generally speaking, you're going to be mailed an ID card, or you're going to have to go online through the mobile app and access a virtual ID card. But anyway, you're going to have that card, and it's going to have very important information on there that you're going to want to present to anyone that you see for medical care. So if you are at a doctor's office, a pharmacy, a lab, you're getting an Xray done, anybody that is giving you medical services, you're gonna want to present that ID card too so that they know they can properly bill your insurance company with that information. Um, that medical provider will go ahead and bill your insurance company, and then if you have a flat dollar co-pay, they might ask you right then and there to pay it. So like I said, you might be checking out at your doctor's office, and they may tell you, like, Yeah, we already checked your insurance. You owe us $50. It's a co-pay. And hopefully, you've done your homework and you know $50 is right, and you're like, Oh, yeah, I do have a $50 co-pay. And you pay the money, and you move on, and you're done. Otherwise, I would tell you don't pay an amount that the doctor's office asks you to do at the checkout, but wait instead for that claim to actually go to the insurance company, be processed, and then ask them to send you a bill for anything that you owe. And again, I tell you that because sometimes insurance companies do make a mistake, and I want to give you the time to, you know, accurately look at the bill that you're paying before you pay it. So anytime you're in a doctor's office, you're asked to, like, pay a balance or pay a certain amount, ask them if they can bill you. Say, Hey, could you run that through my insurance company and then send me a bill for what I owe? They will always say yes, they will do that at least one time. How do I find an In-Network doctor? This is a big question I get asked a lot because I did mention earlier that sometimes you've got a plan where you have out of network coverage, and that's fine. And sometimes in certain circumstances, it makes sense to go out of network. But generally speaking, you're going to want to stay in network because it's going to save you more money. You're going to have better coverage and you're going to pay less out of pocket when you stay in network. So to find an in network doctor, the easiest way to do this is, again, if you are online in your member portal or you've got the mobile app, there's always going to be a feature that's called, like, find care or find a doctor or locate a provider, something like that. And again, they already know your geographical area because they have your address. So when you click that, they know your plan, they know where you live, and they're going to pull up a list of doctors that are in network for your area. So that's probably the best way to find a network doctor. There are other things you can do, too, though. If you would rather speak to somebody, you can simply call member services at the phone number on your ID card and you can say, Hey, I need physical therapy or I need to see a chiropractor or whatever it is that's going on. And if you tell them where you live, they'll pull up your coverage, and they'll be able to help you find an in network doctor. And then finally, the last thing you can do is if you're already seeing a doctor that you really, really, really like and you don't want to change doctors, you can always call that doctor's office directly, and you can say, Hey, you know, I'm switching to HAP, or I'm switching to Cigna. Do you participate? Are you in network? And that doctor's office, somebody there should be able to tell you. So that's kind of it for the night. We listed a few links here. These are links that I trust that I feel like would be very helpful if you wanted to go and learn some more information. The last link in particular, if you want to just have a little fun with health insurance, that link gives you videos to some that are just a little more light hearted. They call them YouTunes and they're really helpful, and they're a little more lighthearted. So if videos is more your thing, go to that last link. You might find that helpful. But that's kind of it for tonight unless there are some questions. I think, Kathy, you'll have to let me know if we have time for it. Yeah, we have a few more minutes. And one of the questions is, is this going to be recorded, and it is recorded, and it will be posted. You'll get an email with these resources that I just posted in the chat as well as another resource and the link to this video. So that's one question answered. There was a couple of them, and I don't know. I will read them out of the Q&A. Some of them will be easy, I guess. Do you want to talk at all about, um, Market insurance? I can. Sure. Just briefly. Yeah. Yeah. So let's say you're somebody out there who doesn't have access to group health insurance. Group health insurance would be like, if you have a job and you're offered, like, medical insurance to join under the group health plan through your employer. But let's say you're not working or you don't have access to group health coverage, you can go out and get an individual healthcare policy, and there is a National Healthcare Exchange just all set up just for this purpose. It's called healthcare.gov. And you can go directly to this website. They will ask you for a lot of information. So don't go there and think you're going to be done in 5 minutes. You're not. They're going to ask you some information. They are going to check to see if you're eligible for a subsidy. So they're going to ask you some information about your income where you live because you may be eligible for a subsidy, which is where they'll give you, like, a discount on health insurance if you qualify. So that is one resource. Additionally, if you'd rather not do that legwork on your own, you can go to different insurance broker agencies where they have brokers who are licensed to help you find health insurance. And there's a lot of them out there. I know I gave Kathy a flyer in particular on one that's tied to my agency, so it's one that I know you could trust. But it's basically just, you know, a 1-800 number that you call. You talk to a licensed broker who can help sell you an individual medical policy. If you are young, I will tell you that, you know, they'll ask you some questions about your own individual situation. And there are plans out there that are called, like, catastrophic plans. They're available for individuals that are under 30-years-old. So if you're somebody sitting out here who actually is not insured and you're like, Okay, I really do need health insurance, or maybe you're someone who's on your parents plan and you're you're gonna age out, and you're gonna be losing your health insurance soon. And if you're not working and you don't have access, and you're like, Okay, I need coverage soon, that is a really good option. And like I said, you can call these services, they'll ask you some questions about yourself. But if you are under 30, maybe you want to get just like a catastrophic plan, which means that it's not going to cover everything. However, worst case scenario, again, you get hit by a car or you have really high healthcare expenses for whatever reason, it would at least give you the protection of coverage. So a lot of young folks like these catastrophic plans, and, you know, depending on your situation, it can really make sense. Wow, thank you so much. You gave so much great information, so many great terms that sometimes get confusing. So hopefully that brought clarity to the group. So knowledgeable. So thank you so much for being here tonight and sharing your wisdom with the audience. We're at the end at 6:30, but I do want to just before we end today, I do want to mention that our next class is coming up. Like I said earlier in the presentation, we offer Adulting 101 every month. Next month, it will be on Monday, March 3 at 7 pm And it's all about organization. It's called Get it Together Time and Organization Tips to Thrive. So we hope you'll join us for that. Again, I want to thank Melissa for teaching us all about medical insurance today. This was recorded, and I will be handing out resources. You'll get an email probably tomorrow from me. The video probably won't be up for another week, though. So thank you all for attending. I appreciate it. Thank you, Kathy. Take care, everyone.