Health Insurance Terms You Need to Know (in the U.S.)

Let’s start with a breathing exercise. Okay? In through the nose… and out through the mouth…. Today we’re getting into a calm frame of
mind, because we’re gonna talk about health insurance. [♪♩INTRO] Health insurance can be a super confusing
and frustrating thing to deal with. But it’s a huge part of adulting! Since we don’t have a crystal ball for how
the future of American health care will turn out, we won’t be talking today about what
kind of public or private health care plan options might be available to you. Instead, this will be a primer on the very
basics of health insurance for an individual, regardless of where your insurance is coming
from. Now, the next time you’re choosing a plan
or someone asks you how it works, it won’t all seem like some alien language. First up, let’s talk about your insurance
policy that you’ll buy from your health insurance company. This is the plan that says how much you’re
paying and what kind of services the insurance company will pay for, including routine checkups
and emergency care. Insurance policies usually last for one year
and you’ll typically sign up for a new one around December or January, unless your employment
or life changes. Many health insurance policies exclude dental
and vision coverage, so you’ll need to buy an additional policy to cover those things
if you have, uh, eyes and teeth. [laughter, because what else?] When choosing your insurance policy, it’s
really important to understand how much your premium will be. The premium is how much you pay each month
for the service, just like Netflix. If you get your health insurance through your
company, they might automatically deduct the payments from your paycheck. If you signed up for a plan through the Affordable
Care Act or a private insurer, you’re in charge of remembering to pay the premium each
month. How much your premium costs will be largely
related to your deductible. The deductible is how much you have to pay
for your health care before the insurance company will start reimbursing claims, the
bill for the service. Usually the doctor’s office or hospital
that you went to will send the claim, aka the bill, directly to your insurance company. If your deductible is high, like, say, six
thousand dollars, that means you will have to pay out of pocket for six thousand dollars’
worth of services before your insurance kicks in and starts reimbursing claims. But! Even if you haven’t met your deductible,
most insurance plans do cover almost all of the costs of routine preventative care, like
getting a yearly checkup or a gynecological exam. Pretty much every plan defines routine care differently,
so it’s a good thing to read up on when picking a plan. They make it really confusing. The type of health insurance company you’re
buying a plan from might make a difference when it comes to choosing which doctors you
can see. If you’ve ever heard of HMOs, AKA health
maintenance organizations, they only cover procedures performed by certain professionals
in a network. You’ll want to make sure that the doctor
you go to is in network for your HMO. But wait! If your health insurance comes through a PPO,
or a preferred provider organization, that means they’ll cover your doctor visit at
different rates depending if that doctor is in-network or not. Whether you get health insurance through an
HMO or a PPO, make sure you know whether your doctor is in network and prepare to shell
out accordingly. If it’s hard to figure out by googling,
you can usually just call a doctor’s office and ask them if they can work with your insurance
plan. After you sign up for a health care plan,
the company might require that you choose a primary care provider. Lucky you, we made a whole entire video for
this already! When you go to a clinic or hospital for any
kind of care, you may need to break out your wallet for a copayment, which is a fixed amount
expected to be paid to the doctor’s office when the service is rendered. So let’s say that you’ve spent enough
on health care this year that you meet the cutoff for your deductible. Awesome. Insurance will cover everything now, right? Well, not quite. You might still need to pay coinsurance on
any additional doctor’s visits for that year. Coinsurance is usually a percentage of the
bill, not a fixed amount. Health insurance companies sometimes describe
it as “your share of the costs of a health service,” because yay, don’t we all love
sharing. So, we could go on about how healthcare works
for a ridiculously long time. But ultimately, the most important thing to
understand about your health insurance plan is—as much as you probably don’t want to—pay attention. Health insurance is weird and complicated
and the companies themselves do not always get everything right, and mistakes can happen
when it comes to billing for claims. Read your plan when you sign up, read the
bills when they come in and make sure that your insurer is covering everything they are
supposed to pay for. If you go to the doctor and then suddenly
get a bill for a service you thought was covered, do your research and be prepared to fight
for what you deserve. The best way to resolve a conflict over an
insurance bill is usually to call up the company and ask for a real live human to help you
solve the problem. Politeness goes a long way when dealing
with insurance companies. And remember, breathe deeply. [breathing deeply] You got this. Thank you for joining us! If you want to learn more about adulting with
Rachel and me, you can subscribe to How to Adult at And if you liked this episode and want to
support this channel, consider becoming a patreon patron at —guided meditation with Hank. I’m going to get right down in the microphone… That’d be a good… P4A perk. Yeah. Guided sleep meditation with Hank. [off-screen]
ASMR. [off-screen]
Hank’s AMR… AMR. Hank’s arm. [laughter] My arm talks to you about sleep. It’d be really hard to send that to you in the mail. [laughter] You can’t have my arm! Anyway, let’s do this thing. Before my legs fall off. Eventually this is not comfortable anymore. [off-screen]
Yeah, you can de-pretzel. De-pretzel. Deep pretzel. Deep pretzel: IBM’s new supercomputer. Yeah. [laughter] [off-screen]
It’s got a built-in food court. Read your—read your plan when you sign up. You messed me up. Our eyes met! [laughter] Read your plan! Noooooo! It’s too long!

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30 thoughts on “Health Insurance Terms You Need to Know (in the U.S.)

  1. Inb4 citizens of every other industrialized nation mocking the U.S. for its rapacious, for-profit based healthcare system.

  2. I'm 18 and this terrifies me more than taxes and car payments. Guess I'll just exercise and stay fit and go to the doctor once I'm 30 or almost die

  3. What happens to the healthcare of uninsured people in a terrorist attack. Do they have to pay more for ongoing treatment,than the friend standing next to them with insurance?

  4. wow, as a canadian, this is so interesting…. like why would a country 10x as big as my own have such a basic human right so convoluted and complicated?

  5. There are actually 2 other types of providers that you may find yourself with that weren't mentioned here:

    -Exclusive Provider Organizations (EPOs) are similar to HMOs in that they usually only allow for in-network providers, and may even be more selective in their provider choices. However, unlike HMOs, they don't usually require referrals to go see specialists – you can choose to visit an in-network specialist at your own discretion instead of needing your doctor to prescribe the specialist after an examination. So although you might have fewer options overall, your ability to exercise those options is far greater.

    -Point of Service (POS) plans can be thought of as kind of hybrid HMO/PPO plans – though they still require in-network providers for most of their benefits, they'll provide a little bit of coverage for out-of-network providers and specialists if used (though you'll still be eating a greater share of the costs, naturally).

  6. I always start polite-but i have had certain times that screaming profanities into the phone is what got me results after months of getting nowhere….refusing to hang up until the problem is resolved can work too….they usually arent allowed to hang up on you…

  7. I recently got a "real job" and came off my parents' health insurance… two months later spontaneously ended up in the ER and hospital for almost a week. Now it's been just over a month since and I'm getting all these bills because the hospital gave me out of network doctors, even though they were aware of my health insurance information. So now I have to appeal and repeatedly fight my insurance provider to help me… main takeaway from this experience is that human beings should not have to worry about choosing being getting needed medical attention and being in debt forever. Free healthcare for all!!! I'm glad this video is out, I had to figure this stuff out the hard way haha

  8. Could you guys do a video about how to correctly go to the movies? My sister always does some mystical stuff before we go, having us end up with reserved seats, snacks(usually taken from a convenience store), and popcorn/drinks, all to a movie that is having its first showing. She's too busy for me to ask, but I want to know her ways.

  9. Thank you so much for this! I aged out of my parent's health insurance plan, and applying for my own is so confusing!

  10. Hey could you guys to a video on what we need to know about President Trumps tax reform? I have been looking for objective videos on information but have failed to find. Everyone is so extreme and looking for information is becoming overwhelming! I just want to understand without claimsmakers sharing their bias on both sides! Hope you guys can help!

  11. Thanks for this. You confirmed that I cannot afford to get health insurance 😂… so yeah… but really thanks because I was so confused.

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