How To Navigate Health Insurance Changes With Psoriasis
Curated by Claudia Shannon / Research Scientist / ishonest
When I was offered a new job at a nonprofit last May, I felt conflicted about taking it. I was ready for a career change after essentially doing the same kind of work for over two decades at four different places. But switching jobs would alter my life in many ways, including requiring me to select a new health insurance provider.
I liked my doctors and didnt want to lose them. My dermatologist, Christie Carroll, MD, takes great care in helping me manage my psoriasis and eczema. I also had good pharmacy benefit coverage for my medications, such as my biologic for psoriasis, Skyrizi. Any time I have an insurance change Im concerned about whether the new provider will cover my biologic or make me try and fail other medications before I can get it.
Another complication of the new job: The nonprofit couldnt bring me onboard until Id personally raised the funds to cover the cost of both my salary and benefits. I didnt know how quickly I could meet this goal.
I did end up accepting the new job and am set to start utilizing my new health insurance with Anthem Blue Cross Blue Shield this month. Things worked out well overall, but the process of moving over to the new health insurance took patience and effort.
Continuing Health Insurance After Leaving My Job
Choosing an Employer-Based Health Plan
Evaluating the Emotional and Financial Cost
You can read more about my experiences in my blog for ishonest and on mywebsite.
Get The Details About Health Insurance Eligibility And Answers To Frequently Asked Questions
In the United States, health insurance helps you and your family access necessary care, and it protects you from unaffordable medical bills. But healthcare can be confusing for immigrants because there isnt a single form of health insurance in the United States. Instead, the U.S. healthcare system is a combination of publicly and privately funded programs with different requirements and rules for eligibility, depending on factors like where you live, your immigration status, and your income.
The good news is that many resources exist to help you understand your insurance options so you and your family can be protected. This article will explain what you need to know about U.S. healthcare as an immigrant, including the difference between publicly and privately funded programs and the definitions of common terms like primary care physician and PPO.
Two Important Additional Resources
The US Department of Health and Human Services has just launched a comprehensive health insurance search tool at healthcare.gov. Here you can find insurance options based on your situation and stay abreast of policy changes in healthcare reform.
Every state has an insurance commission that regulates the insurance industry, enforces laws, and assists consumers. This agency enforces the laws governing insurance coverage of all treatments, including integrative therapies.
If you have questions about the requirements for insurance coverage of specific integrative therapies, call the state insurance commissioner.
To locate the insurance commissioner’s office for your state, go to The National Association of Insurance Commissioners website. The insurance commissioner or regulator’s office might have different names in different states, such as the Insurance Administration . Each office has a toll-free consumer assistance number.
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Is Hdhp Right For You
Many people face the question of whether or not to go with an HDHP. It costs less upfront, which is appealing. And putting money in an HSA seems smart. If youre young and healthy, it may save you some money.
But youll want to know how youd pay big medical or hospital bills if you needed medical care and hadnt reached your deductible. And you should honestly consider whether youd be tempted to skip seeing a doctor if you had to pay the full cost of the visit as that would defeat the whole purpose of having health insurance.
Coronavirus Testing and Care
The Families First Coronavirus Response Act designates that testing for COVID-19 should be free to all Americans, whether they are insured or not. Care for coronavirus, on the other hand, may or may not be covered. Some insurance agencies are waiving costs like copays and deductibles, but some are not. Those who are uninsured may be able to get assistance from the government to help with costs for care.
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Understanding Health Insurance Terminology
Its easy to get overwhelmed with all of the terminology used in the insurance world, so lets start by breaking it down into bite-sized chunks. There are a lot of terms involved, but I feel that the following are the most important to familiarize yourself with.
Open Enrollment
Unless you have a major life change open enrollment is the only time during the year you can make changes to your health insurance, except for purpose of dropping it completely. Depending on the company, open enrollment can happen at any time of the year, so check with your own company for specific details.
Provider
The doctor or health care organization you go to for medical attention.
Premium
The amount that you pay out of pocket in order to have health insurance. Often, if you are under an employer account, they will pay a certain portion of that total amount.
Deductible
The amount you pay out of pocket before the insurance provider will pick up the cost .
Out-of-pocket Maximum
This is the total amount that you can pay out of pocket before the plan covers all of the remaining expenses for the year. Copays and coinsurance costs are included in this total.
Copay
Coinsurance
Rather than paying a flat fee , coinsurance involves splitting the total amount of any provider visits with your insurance. For example, if your coinsurance is 70%/30%, then your plan would immediately pay 70% of the total cost of the doctor visit and you would be left responsible for the remaining 30%.
Ask Almost Anyone Who Has Lived In The United States And They Will Have A Health Insurance Story To Tell You Even If They Dont They Most Certainly Know Someone Who Does
Health insurance is notoriously expensive and complicated in the U.S. Unlike Canada, most of Europe, and many other countries where universal health care provides a basic level of coverage to all citizens, the U.S. has a mixture of private and two kinds of government-run programs. Basic coverage in California and Florida can cost $450 per month, while similar plans in New York can cost upwards of $600 per month.
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Understand Whats In The Medical Network
Maybe you have a favorite doctor or specialist and youre looking for a plan that ensures theyre in network. While thats helpful, remember that your condition may require additional specialists, especially if its progressive. For that reason, it can be crucial to select a plan that either has a large medical network or covers out-of-network medical care at a reasonable rate, says Adrian Mak, CEO of AdvisorSmith, a business and consumer insurance firm.
Also, if you do expect to visit new specialists, he suggests choosing a preferred provider organization plan that doesnt require specialist referrals. This can cut down on doctor visits and related costs. By comparison, a health maintenance organization plan might require you to see a primary care physician for a referral every time you need to visit a new specialist.
The out-of-pocket maximum is another important consideration when comparing plans, says Mak. This number tells you the most that youll pay for in-network medical care during a calendar year when enrolled in a health insurance plan.
How Do I Pay For Integrative And Alternative Treatments
If you are seeking insurance coverage for integrative therapies, you may wish to explore financial issues at the same time you explore care options, since cost may be an important factor in making a decision to pursue particular treatment options. Alternatively, you may decide to explore the cost of care and your insurance coverage after deciding which treatment you want to do. Whatever process you choose, know that coverage for integrative therapies varies considerably between health plans and tends to be quite limited. It is estimated that consumers pay directly for 80% of integrative therapies. Prior to receiving integrative therapies, you should ask your provider and/or your insurance company:
- Is the therapy covered by my insurance, and will the therapy be covered for any condition or only for certain conditions?
- Who is authorized to deliver the services? Do the services need to be delivered by specific practitioners ?
A limited number of insurance companies offer integrative therapy insurance coverage. Usually, the coverage is one of the following three types:
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Why You Want Healthcare As An Immigrant
Nobody plans to get sick or hurt, but unfortunately, it can happen to anyone and when it does, it pays to be insured.
Think of health insurance as a contract between you and the insurance company. When you buy a plan, the company agrees to pay part of your medical costs. Health insurance helps cover the costs of care like emergency room visits, medicine, and regular check-ups with your doctor so you and your family can stay in good health.
The Affordable Care Act requires most U.S. citizens and lawfully present immigrants to a minimum level of coverage, but there isnt a penalty if you dont have health insurance.
However, uninsured adults in the United States are more likely to have poor health than insured adults. And according to the Kaiser Family Foundation, people of color are less likely to have health insurance than white people. Thats a problem because people without insurance have worse access to care than people who are insured, and when the uninsured do seek care, they often face unaffordable medical bills.
How To Navigate Health Insurance For Travel Nurses
The importance of having health insurance coverage is paramount for everyone especially travel nurses. However, most travel nurses depend solely on their employers for health insurance coverage. Unlike traditional nurses, travel nurses often change from agency to agency, making keeping health insurance rather complicated.
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What If I Don’t Have Employer
Most Americans’ healthcare coverage is “attached to” or supplied by a larger system, such as an employer. If your employer does not offer health care benefits, you may have other options.If you are disabled, over the age of 65, or have young children, you may be eligible for financial aid . To learn more, visit the Centers for Medicare and Medicaid Services. In addition, some states offer healthcare coverage. Check the US Department of Health and Human Services’ website for more information.
Its Called The Affordable Care Act Not The Simplified Care Act
The positive effects of the ACA are numerous. It makes it so that you cannot be turned down for health insurance if you have a pre-existing medical condition. It expands Medicare and Medicaid coverage so that more people who couldnt previously afford health insurance now can. It allows young adults to stay on their parents coverage plan until they are 26 years old.
Another positive effect was supposed to be consolidation. With the ACA enacted into law, everyone should be able to go on Healthcare.gov to access the health insurance marketplace . Because of that, some thought that health insurance agents wouldnt be needed anymore because Healthcare.gov would have all the answers and be simple to use.
That isnt the case, though. It can be difficult to navigate the different tiers on Healthcare.gov, especially if you dont know what youre looking for. As part of the law, the ACA requires everyone to have health insurance, so many of the marketplaces customers are people who have never had to sign up before.
Many people are caught off by jargon and the apparent cost. Small business owners have questions about providing for their employees. The ACA has expanded and changed the healthcare industry in more ways than one, but it hasnt made it any easier to navigate.
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Find Out Which Services Most Plans Decline
Kirsten Rohrs Schmitt is an accomplished professional editor, writer, proofreader, and fact-checker. She has expertise in finance, investing, real estate, and world history. Throughout her career, she has written and edited content for numerous consumer magazines and websites, crafted resumes and social media content for business owners, and created collateral for academia and nonprofits. Kirsten is also the founder and director of Your Best Edit find her on LinkedIn and Facebook.
Navigating health insurance coverage is a monumental task. Consumers generally have no say in which services are rendered, which services are covered, and how much they will ultimately be responsible for paying. It is not an uncommon scenario that a doctor requests a service, the patient follows the doctor’s orders, insurance pays only a portion or none at all, and the patient is left holding the bagand the bill.
Other common scenarios: A patient calls the doctor to ask for the price of a particular test or treatment, only to be told the price is unknown. Or a plan participant calls their health insurer to ask for the customary fee for a serviceto determine how much of it will be coveredonly to be told “it depends.” No one would go into the local electronics store and buy a TV without being told the price, but in medical care, this is basically what patients are expected to do.
How To Navigate Health Insurance During Coronavirus
With the weather warming up, more people are getting out and resuming some regular activities. Even as restrictions loosen, its important to follow proper precautions to limit your exposure to the coronavirus.
If you or a loved one ends up getting sick with COVID-19, the priority is getting the necessary care. While some people only get a mild case similar to a cold, others get respiratory complications resulting in hospitalization and a higher level of care.
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Consider Options Within Your Family
The first place you should look for coverage options is within your family. The Affordable Care Act allows those younger than 26 to be covered under a parents insurance plan.
If you lost your coverage but your spouse still has an employer-sponsored plan, you may be able to enroll in their plan. Check with their health insurance provider on the requirements to add another person outside of the open enrollment period.
Employer Health Insurance Premiums Have Risen 22% In 5 Years And Wages Can’t Keep Upyour Browser Indicates If You’ve Visited This Link
With so much attention paid to the skyrocketing cost of consumer goods, many Americans might not have noticed how expensive their employer-sponsored healthinsurance plans have gotten. But a new survey from the Kaiser Family Foundation spells it out: Premiums for family coverage have risen by more than one-fifth over the last five years and nearly one-half over the last 10.
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How Do I Get Covered
If you are employed by a U.S. company, you are likely covered through an insurance plan offered by your employer. Some employers pay for the plan in full, while others may pay part of the fee and require you to pay the remaining cost.
If you have a work visa but plan to be self-employed, you will need to purchase health coverage yourself. You can find a plan in the ACAs Health Insurance Marketplace during the enrollment time, typically running from November to December for the following year. If you arrive to the US outside of the enrollment period, you may still qualify to apply because of your special circumstances.
Look For Wellness Benefits
In both employer offerings and your health insurance plan, dig deeper for perks and benefits related to wellness, Haney advises. These are often not widely promoted, but they can help optimize your health. For example, you could get a free or low-cost gym membership, take a healthy cooking class, talk with a weight loss counselor, or get telehealth sessions with a mental health therapist.
Look beyond what insurance is providing for managing your diagnosed condition and into what you can do for your health overall, he says. Ultimately, we all must become our best advocates in taking care of ourselves physically as well as financially.
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Resources From Your Current Health Insurance Provider
Insurance providers offer resources for members to help them navigate the changing health care landscape. From advice on limiting exposure to the coronavirus to resources for getting treatment, you can get reliable information and health support to carry you and your family through this uncertain time.
Below are some resources you may be able to access through your health insurance provider.
Website or Mobile App
Many insurance providers such as Texas Health Aetna have dedicated websites with COVID-19 information for members. This can include drive-through testing locations for members, guidelines for protecting yourself and your family, information on navigating insurance costs related to coronavirus and more.
Telehealth Appointments
Since limiting contact is a good way to slow the spread of the coronavirus, many health professionals are offering telehealth appointments. You can talk to a physician about your concerns with certain health symptoms or COVID-19 symptoms.
Phone
Some health providers are offering patients access to a nurse hotline for COVID-19 concerns and symptoms. Others, such as Texas Health Aetna, offer daily guidance, updates and tips via text message based on recommendations from the Centers for Disease Control and Prevention .
