Navigating the health insurance system

Health insurance has been a major topic that has been debated by many politicians, a topic to consider when choosing the next president, and has been something confusing to many when deciding on the best and most affordable plan.

Health insurance comes in many different forms, has many advantages and disadvantages and can be obtained in different ways. There are many components to health insurance when considering what plan best suites each individual customer such as costs and benefits.

“In general all health insurance brands try to provide tools and resources so members can live healthy productive lives,” said Keith Dolan, regional executive at BlueShield of Northeastern New York.

Dolan said health insurance is a product a consumer pays a monthly premium for, and it works similarly to car insurance. He said like car insurance, consumers pay a monthly bill known as the premium annually, even if that product isn’t being utilized, until it does need to be utilized for a medical bill in which the health insurance company and consumer will both pay for part of the costs which varies depending on which plan a member selects. The customer will pay their share of costs for health care through deductibles, copay or coinsurance or out of pocket.

According to BlueShield, health insurance helps protect individuals and families from unexpected costs of health care.

“Everyone is different, so it’s important to choose a health insurance that works for your lifestyle and your financial picture,” according to a document provided by Amber Hartman, public relations manager at Blueshield.

Costs of health insurance can vary depending on which product or plan a person chooses and whether they get insurance through their employer, through a family plan or if they purchase individual coverage.

When choosing a plan, it’s important to consider total health care costs that include premiums, deductibles, copayments, coinsurances, maximum out of pocket, supplemental health insurance products, dental insurance, vision insurance, gap insurance and critical insurance, according to the document.

According to CDPHP, a deductible is the amount a person pays for health care services before insurance begins working. A copay is a set amount a person pays for a health care service at the same time the service is rendered. A coinsurance is the amount a person pays for a health care service. For example if a person is responsible to pay 20 percent and a bill is $150, then the coinsurance would be $30.

Dolan said BlueShield of Northeastern New York has 27 different products to offer. Within each product there are different plans that offer a variety of different premiums and different copays, coinsurance and deductibles, all depending on what a customer’s preference is.

He said as an example, one person may be attracted to a plan that includes a high deductible and may have a lower premium.

“Many employers offer health insurance as part of the benefits they offer to their employees, which helps offset the cost of health insurance,” according to the BlueShield document. “Additionally you may qualify for a subsidy which will offset the cost of your health insurance. The main factor for subsidies depends on income, family size and the market you live in.”

According to BlueShield, some ways a person who may not be able to afford health insurance can find an affordable health care plan is to : shop for the right coverage and educate themselves on all types of coverage, take advantage of all the tools and resources offered by a health insurance company and do research, find the right setting of care, use a preferred lab provider and ask about generic drug options.

Health care can also be obtained different ways including through an employer, family or through an individual plan.

“Most individuals receive health insurance through their employer. Those 65 and older qualify for Medicare either as an individual or perhaps through their employer,” said Natalia Burkart, public relations specialist with CDPHP. “Lower-income individuals may qualify for Medicaid or the Essential Plan, and children, for Child Health Plus plans. Anyone else can purchase individual coverage through the New York State of Health marketplace.”

She said by email that anyone can shop for CDPHP plans on their website. CDPHP takes into account how many people need coverage, income level, where a person lives and some other factors, and then returns the plans that best match the customer’s situation. Lower-income individuals could also qualify for subsidies to offset the cost of their health insurance.

Like any other product, health insurance comes with some positives and some challenges.

Dolan said health insurance is something he “strongly recommends” everyone have.

“The positives are tremendous,” he said. “It’s 100 percent going to save their lives more times than not.”

“To be without care and diagnosed with a disease, someone has to pay,” Dolan said. “It’s more expensive as a society as a whole.”

Most health insurance companies also offer a variety of health benefits. At BlueShield, they offer wellness benefits for customers to encourage a healthy lifestyle. Those benefit could include something such as a gym membership.

“We’re looking to help people get and stay healthy, and we offer several programs, services, and resources to do just that,” Burkart said. “Like the CDPHP Care team, for example, made up of nurses, registered dietitians and social workers who can monitor members’ health needs and work closely with their doctors. Our CDPHP Life Points program is another great example — we reward members for the healthy things they’re doing anyway, like getting an annual physical or flu shot. The points they earn can then be redeemed for gift cards for a variety of retailers.”

One major challenge with health insurance is how complicated it can be to understand.

Dolan said one way BlueShield is trying make it easier to understand is through their Clarity Project which will make it simpler to digest, and will take it down to a first grade reading level.

“Health insurance can be complex and difficult to understand. We’re trying to make it simpler,” Dolan said.