Healthcare and health insurance can be complicated. For many students, college can be the first time they are confronted with how insurance actually works. In this post, we’ll set up the basics around health insurance and review some key terms.
How health insurance works
Simply put, health insurance companies pay for some or all of the cost of medical expenses. Exactly how much health insurance pays towards healthcare costs depends on:
- the insurance plan;
- the type of visit or procedure; and
- the provider (e.g., whether or not the provider is in the health insurances’ “network”).
You can get health insurance in a variety of ways:
- individual health insurance (example: enrolling through a state’s Exchange or Affordable Care Act program)
- employer insurance (example: entity you work for providers insurance), or
- student insurance (example: UNC provides an option for students to enroll in a student health care plan).
Breaking down health insurance terms
- Premium: In essence, this is the price of admission, or what you regularly pay to have your insurance plan (for example: X dollars a month).
- Co-payment (“co-pay”): An amount of the visit/procedure you pay up-front (for example: paying $20 for a doctor’s visit).
- Co-insurance: A percentage of a bill the patient is required to pay, after accounting for co-payments, deductibles, and any other discounts.
- Coverage: The amount the health insurance company pays for each procedure, service or visit. This depends on the health plan, and might be a percentage (for example: 60% of the cost), or may be a fixed amount for certain procedures (for example: will cover 100% of preventative care services). Usually, you can find some basic information on coverage on your insurance card.
- In-network/ Out-of-network: Insurance companies will have lists of providers that accept their specific insurance brand (“in-network”). This is akin to businesses accepting certain kinds of payment methods: one might take Visa, Mastercard and American Express; while another might only Visa (“out of network” for American Express and Mastercard). How do you find out which providers are in vs. out of network? Health insurance companies usually provide a directory/listing of in-network providers (see below for tips on finding out more about your plan). Or, if you have a specific provider in mind, you can contact them to ask what types of health insurance they accept. Learn whether your insurance is in-network at Campus Health Services here.
- Explanation of benefits: This is a break-down of the total costs
- Deductibles: This is a set amount you have to pay each year in medical bills before the health insurance company starts paying. So, for example, if your plan’s deductible is $300, then you have to spend $300 before your health insurance kicks in and starts paying for medical costs. Note that as a general rule, the higher your premium (the cost to have insurance), the lower your deductible.
Maximizing your insurance
Insurance plans vary considerably in what they cover, and can be worthwhile to what extent insurance plans cover various visits and procedures. If you are concerned about coverage, cost or confidentiality (if you’re on a shared plan with others), you can contact insurance companies before you visit a provider. To do this:
- First, check your insurance card, which will usually have information on co-insurance, deductibles, prescription drug coverage, and emergency coverage.
- For more detailed information, you can often look online to see what your specific plan covers. Many insurance plans have an option to create online accounts, where you can access information on specific plan benefits, and look for “in-network” providers.
- You can also call the insurance company to inquire about coverage for a specific procedure, visit or prescription drug coverage. The contact information is usually on the card.
Additionally, for UNC Students: more information on UNC’s student health insurance policy, and in-network insurance providers at UNC Campus Health Services can be found on the UNC Campus Health Services website.