Adulting 101: Health Insurance Basics

It’s that time of the year again!

This is the first year that I have joined the ranks of working adults across the United States participating in Open Enrollment for benefits. Typically, Open Enrollment is a limited time frame when employees (or just citizens, if you’re purchasing health insurance privately) are able to sign up for or change their insurance plans. For my plan, the benefit calendar is January 1st to December 31st, but I will be covered as of November 1st for the rest of this year because I just moved into an eligible job.

I was more than a little clueless when I started the process earlier this month. There are a lot of factors you need to look at when you’re picking a plan!

My employer has three main medical plans to choose from, and each has two vision benefits options you can add. In addition, we can get dental insurance (separately). There are other options as well but these are the three I opted for. My employer also automatically enrolls eligible employees in short- and long-term disabilities at 60% of base salary, Accidental Death and Dismemberment (morbid, huh?) at 1x base salary, and Basic Life at 1x base salary.

I chose a slightly more expensive medical plan as I have a few medical conditions that I would like to get checked out beyond my wonderful PCP at Student Health. (Side note: Student Health is an amazing resource to take advantage of at your college or university! Often, you already pay for access to it as a part of your tuition, so why not use it when you need it? Mental health services are also included if you just need someone to talk to!)

Because of my medical conditions and the fact that my parents’ insurance isn’t the greatest (my dad’s company doesn’t offer any good plans that are affordable), I haven’t been to a non-Student Health doc in years. Figured I might as well play catch up and get my health on track now while I’m young and can make positive changes easier.

If you are looking at taking this step yourself, I have a few pieces of advice:

The biggest thing you need to consider if you are purchasing health insurance: how much will you use it? Do you only go to the doctor for a check-up if/when work or your mom demand it? Or do you have a medical condition (like migraines, or allergies) that require help from a doctor (or a prescription to manage)? If the former, you can probably get away with a cheaper, basic plan; if the latter, the more in-depth plans may be worth considering.

You also have to look at the cost. Will your insurance payments be deducted out of your pay, and are you able to afford this money missing from your paycheck? If you get a cheaper plan, you may have a higher deductible, meaning you have to pay more out of pocket before your insurance will pay a portion/all of the medical cost. Can you afford the out of pocket costs until that point?

Something recent events in my area have brought to light is the importance of staying in your network. Two majors health systems rule my city, with several slightly smaller ones in the background. Those two big systems will not pay for the patients they cover insurance-wise to go to the competition, which means the patient pays for everything out of pocket. However, if you go to the hospital or doctor associated with (preferred by) your insurance provider, they will cover medically necessary visits and tests within the scope of your plan.

There definitely are more factors to consider, but it depends on the individual. These three considerations are the biggest ones than can affect your insurance purchase decision.

And don’t be afraid to ask for help! I’ve called my health plan customer service with several little questions over the last two weeks, and they are always happy to help. Your parents or co-workers may be willing and able to help answer general questions about health insurance and healthcare concepts as well, so speak up!

I’ve written up a few notes on common insurance terms you may see here. Feel free to take a look and let me know if it’s missing anything big!

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