PSA: What you need to know about health care

Truly. That’s the topic of the day. I’m calling this a “PSA” or “Public Service Announcement,” because the content I’m about to share is something that everyone needs to know. And I’ve got to be honest, when writing this post, I learned quite a bit about how health care works and why we need it. This can be a controversial topic, because I’m sure some of you have struggled with your coverage, have no coverage at all, or live in countries with universal coverage. Therefore, without getting into politics or anything too heavy, my goal today is to share facts and figures, in order to arm us all with knowledge. Sound good?

What you need to know about health care via A Lady Goes West

Healthy living means more than just working out

But why would I want to talk about health care? Well, if you read A Lady Goes West regularly, you know that I’m a big proponent of healthy and balanced living. I don’t see healthy living as just about diet and exercise, I also see it as looking at your overall health and well-being and being proactive about it. Sometimes you need professional help to make sure you are performing at your best and doing everything that you can to stay well. Being that my husband Dave and I just moved, we’ve been looking at all of our accounts, finances and payments, and the topic of health care recently came up. Both Dave and I are pretty go-with-the-flow in picking the most popular and easiest plan, but we realized we should dig deeper. That’s why it was an opportune time for the folks at UnitedHealthcare to reach out to me with some information they are trying to share about the fact that it’s open enrollment time for many people in the U.S. But let’s start with a little background information about me …

My personal health-care story

I still remember when I found out I would be getting 100 percent paid health-care coverage at one of my first corporate jobs out of college, and I felt like such a grown up. Since that time, I’ve been covered by my employer, covered by myself as an individual for a while and also become a dependent on my husband’s plan. Through all of these changes, I’ve been pretty in-the-dark about what my plan actually entailed, and I’ve always wished I spent the time to understand it better. That’s all going to change now …

Knock on wood, I haven’t had any medical emergencies, but I go to the doctor at least once-a-year for my annual check-up and for other reasons here and there. I find that doctor visits provide me with a great chance to ask questions and get real advice on things going on in my life. For instance, when I used to live in an a very loud apartment above a train track in Orlando, my doctor told me on rough nights that taking a Benadryl to go to sleep wouldn’t be such a bad idea. She was right, because it helped. At my first doctor visit in San Francisco a few months after I moved here, my doctor recognized me as a group fitness instructor whom she had taken a class from, and so we instantly connected on the physical demands of my work. And finally, at my last visit a few weeks ago, I even got a great book recommendation from my doctor about processed foods that I’m planning to purchase and read soon. Nonetheless, I always come away from doctor visits feeling loaded up with knowledge and a little peace of mind. 

Even though these doctor visits are just a small part of having health care, they are important. I like to have the ability to see a doctor when I need it, and I’m only able to do that because of my coverage.

And yes, coverage can be expensive. And yes, you’re probably thinking, it’s not that easy. Because if you are self-employed, own a business or work a few part-time jobs (like I do in the fitness industry), it can be daunting to figure out how to get yourself insured without spending your entire monthly income. Well the good news is that it’s easier than ever to get covered, but you have to know what’s available and what’s right for you.

Facts on the state of health care in the U.S.

Let’s get to a few facts, according to UnitedHealthcare

  • Employers started offering health benefits in the early 1940s as a way to get around World War II wage and price controls. Because companies weren’t allowed to offer higher salaries, they began offering health care as part of a benefits package.
  • Almost 80 percent of uninsured people in the U.S. are in working families. It’s not just the unemployed who don’t have insurance.
  • Not having health insurance is the leading cause of personal bankruptcy in the U.S., because paying for a medical emergency out-of-pocket can be very expensive and devastating. 
  • It’s your right as a consumer to know what a medical procedure will cost, and you can always ask for less-expensive alternatives to make sure your care is affordable.
  • Over the past year, there have been many changes in the state of health care in the U.S. due to health-care reform. 

Important health-care terminology

Now that you understand the importance of health care, let’s get to some of the lingo. If you don’t know some of these technical health-care terms, you’re not alone. Check out these commonly used words and acronyms, and click on the underlined words for a link to short videos done by the UnitedHealthcare team, in which people on the street are asked to explain each term. The responses people come up with are pretty funny, and it made me feel better about being in the dark on some of these as well …

  1. What is a PPO? A “PPO” is a preferred provider organization, which is a health plan that has a list of health-care providers you can choose from.
  2. What is a co-pay? The “co-pay” is a flat-fee you pay out-of-pocket each time you visit a doctor.
  3. What is co-insurance? “Co-insurance” is where you share a portion of your medical costs with your health insurer after your deductible has been reached.
  4. What is an OOP limit? The annual limit you’ll have to pay out-of-pocket per year outside of your monthly premium. Also called an “OOP” maximum.
  5. What is a deductible? The “deductible” is the amount you pay during the year for medical services before your insurance starts to pay for them.
  6. What is a premium? The “premium” is the amount you pay every month for health insurance, usually taken out of your paycheck from your employer.
  7. What is an EOB? An “EOB” is an explanation of benefits.
  8. What is a network? A list of doctors, hospitals and other health-care providers who have agreed to accept payments from your insurance provider for negotiated discounted rates. You’ll usually pay less if you stay in your plan’s network.
  9. What is a formulary? A list of generic and brand-name prescription drugs covered by your health plan.
  10. What is a health-insurance exchange? Like a travel website, the health insurance marketplace/exchange is an online place to easily compare health-care plans. This is designed for individuals looking for coverage who don’t get it through their employer.
  11. What and when is open enrollment? It’s the one time during the year when you get to choose your health-care options, start a new plan or change your plan within your medical group (i.e. as an individual in the health-care marketplace or as part of a health-care group where you work) for the rest of the year. While companies are allowed to set their own open enrollment periods for employees throughout the year, the U.S. has set the open enrollment for individuals and families in the U.S. looking for their own coverage from November 15 to February 15. 

That covers many of the terms that you may see thrown around when you start to research coverage. But you’ll also need to know a bit more …

Questions you should ask to compare plans and choose coverage

In order to figure out which plan is right for you and your current situation, you can generally ask these three questions: 

  1. Is your current doctor in the plan’s network?
  2. What exactly does the plan cover? For instance, does it cover physical therapy, special services or the prescriptions you know you will need?
  3. How much does the plan cost outside of just the monthly premium? Be sure to look at the co-insurance, co-pay and the out-of-pocket limit required each year.

And with that, you’re ready to go. If you have good health insurance and are happy with your coverage, then that’s wonderful. But if you’re not insured and you want to be, I’d encourage you to take a look at some of the options out there using the tips above and act before open enrollment in the U.S. ends on February 15.

I know it’s confusing if you’ve ever had a major medical issue, so knowing as much as possible is the best way to handle whatever comes your way. And once again, I’m not a doctor, I’m not a health-care provider, I’m just a Lady who likes to learn things and share that knowledge with you. So I hope you’ve enjoyed this PSA. 

And with that, I’m done. I’ll see you back here tomorrow for my weekly “Friday Favorites.” Have a safe, happy and healthy Thursday. Bye, folks!

**Disclosure: This post was sponsored by UnitedHealthcare, however all the views and opinions are completely my own.

Questions of the day

What’s your number one healthy-living tip? Did you learn anything about health care from this post?

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19 Comments

  1. I have lots of thoughts about health care πŸ˜‰ One is obviously we all need it, medical care can be crazy expensive. My other thought is why does it need to be so complicated (and why is it so difficult to actually get an answer from your insurance company)? Why are there co-pays and coinsurances and out of pocket maximums? It’s insane to expect a typical person to understand insurance terms unless they actually work for an insurance company, haha.

    1. Hi Becky, I know it is confusing. I learned SO much researching and writing this post. I wish I had taken the time to learn all of this sooner. I feel a little more empowered … but of course, still hoping I don’t need to use my insurance for anything major right now. I know you need it for your little one on the way. Save up!! πŸ™‚ And have a happy Thursday, momma friend!

  2. That’s one thing I miss about Canada having just moved to the states at the end of last year, the health care. We still had to pay for things like dentist, naturopath, optometrist, dentist, physio, etc. if we weren’t on a plan, but things like doc visits, emergency room, hospital stays, surgeries were all covered. We still aren’t on a plan down here yet, but it’s definitely something we are looking into!

    1. Hi Char! Yes, so you see the difference first-hand of what it’s like to be covered or not. I’m sure it’s been quite the learning process for you to try to figure out what kind of plan to get in the U.S. Oh, and welcome to America? You only moved a few months ago? Or the last year? What brought you down? And yes, the dentist is important enough to mention twice, for sure! Happy Thursday! πŸ™‚

    1. Hi Megan, Yes, I thought of you when writing that line that some of you may have had your struggles. I sure hope you start to have a better experience soon and get all the way healed. I’m sure through it all you learned a few of these health-care terms, right? Have a good and healthy Thursday, Megan. πŸ™‚

  3. I always make sleep a priority and drink plenty of water! I’m very thankful that my company pays for my insurance, we have our own health plan (self insured), as we are a very large company in the health care industry. We have a clinic and pharmacy at each work campus, as well as a very state of the art fitness center. It’s great!

    1. Hi Jessie! You have all of that at work? That’s awesome! I love to see it when companies take good care of their employees. Hold on to that job! πŸ™‚ And yes, sleep and water are soooo important. Enjoy your Thursday, friend!

  4. I think stress reduction and getting enough sleep are my top recommendations. I could go on and on of course! πŸ™‚ Health care remains a huge issue and I am in the process of figuring out what I want to do next so thank you for putting together all this info to share. πŸ™‚

    1. Hi Lauren, Yes, of course you are. As someone who is in fitness and doing various independent work, you’re going to have to do some research to find what’s right for you. Good luck, lady!

    1. Thanks, Jessica! Yes, I bet it’s totally different there! I’ve always wanted to go to NZ!! The birthplace of my beloved Les Mills brand! πŸ™‚

  5. I’m all about preventative care, although that’s hard for some people to think about πŸ™‚ staying informed, keeping active, and going to the doctor for check-ups can help us stay healthy and keep medical costs down (among many other things, obviously). I didn’t know that not having health care is a leading cause of bankruptcy…makes sense, though! Thanks for sharing this!!

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