Understanding healthcare terms is hard sometimes and can be, let’s face it downright confusing.
Affordable Care Act: The 2010 federal health reform law has been generally upheld by the U.S. Supreme Court. Its centerpiece is that everyone must purchase health insurance unless they fall into a narrow area of exemptions. Those who don’t purchase insurance face penalties. The insurance can be purchased online at a reduced rate on state exchanges. In a lingering challenge to the controversial law, the U.S. Supreme Court must still decide whether the federal government can provide subsidies to reduce the cost of coverage in states that chose not to operate their own state exchanges. In those states, the federal government is running them.
Catastrophic plans: These plans offer low premiums, but have very high out-of-pocket costs for co-pays and deductibles. They’re available only to consumers under 30 or consumers with a “hardship exemption” — those whom the marketplace has determined are unable to afford other health coverage. Though they also cover some preventive care, the goal of these plans is to guard against worst-case scenarios.
Certified application counselor: A federally trained counselor who assists consumers in sorting out their health coverage options on the state exchange or for Medicaid programs. Unlike navigators, who require more training, they cannot assist consumers in an appeal of a marketplace decision. The assistance is free.
Copayment: A fixed cost — for example, $20 — that consumers pay for certain health services, such as a doctor’s visit.
Coinsurance: A percentage of the cost — for example, 20% — that consumers pay for certain health services, such as a doctor’s visit.
Deductible: The amount a consumer pays for health insurance before the insurer begins to pay. For example, if a plan’s deductible is $1,000, the consumer pays that amount first before coverage kicks in. The deductible may not apply to all services.
See video help: How Do Deductibles and Copays Work? https://www.youtube.com/watch?v=kT3H9pBP8fg
Metal levels: Five categories of insurance plans — platinum, gold, silver, bronze and catastrophic — that indicate roughly the percentage of cost the consumer will have to cover. For example, a platinum plan generally has higher monthly premiums but covers about 90% of the cost of care, while a bronze plan is less costly each month but consumers will pay more when they seek care.
See video help: Health Insurance 101: What are the metal tiers? https://www.youtube.com/watch?v=4e7YcD3vDfc
Narrow networks: These plans are being offered more frequently across the U.S. and in Michigan. They offer lower monthly premiums that can save consumers thousands of dollars. The trade-off: The consumer pays full price for any care provided outside the network (except in emergencies).
Navigator: A federally trained staffer who can help consumers enroll in the marketplace or in Medicaid plans. Michigan has several organizations whose goal is outreach and to provide navigators to consumers. Navigators can assist consumers in any appeal of a marketplace decision. The assistance is free.
See video: Local Affordable Care Act navigator tells you what you need to know https://www.youtube.com/watch?v=Hr5Q2dxc_GY
Out-of-pocket costs: The consumer’s share of health costs, including deductibles, coinsurance and copayments for covered services, in addition to costs for services that aren’t covered.
Premium: The cost for a health plan. It’s usually paid by the consumer or employer monthly or quarterly. It does not count toward meeting a deductible.
Special enrollment period: The next open enrollment period for the Health Insurance Marketplace is November 15th, 2014 through February 15th, 2015. Outside of this window, someone may qualify for a special enrollment period. This period lasts until 60 days after a qualifying life event, such as a job loss, birth, or divorce.
See related video: Health Insurance Explained https://www.youtube.com/watch?v=-58VD3z7ZiQ
Still confused? That’s ok you can get – Application assistance: There will be people available in every state to help consumers understand their health coverage options and how to sign up for a plan through the Health Insurance Marketplace.
In-person help will have many different names, but the important thing is that they are there to help you. They may be called navigators, in-person assisters (IPA), certified application counselors (CAC), or something else. No matter what they are called, they are there to provide unbiased assistance.
Questions? Call us at 1-800-318-2596 or (TTY: 1-855-889-4325)