So WTF is Health Insurance Anyway?

If you’re a “real adult” the only time you’ve likely been to the doctor since your required pre-college or pre-employment exam, is if you’ve had an STD scare or were literally on your deathbed. Even then, you probably only made it to your local urgent care. For those of you who are lucky, you’re under 26 and still covered by your parent’s health insurance plan, which makes health care seem free (or cheap enough to use anyway). But for those of you over the age of 26, or simply hated by your genetic donors, you know there’s much more to the cost of your every visit.

You’re emailed every year by your employer during open enrollment to update your benefits but seriously what do any of the acronyms mean? How can you tell the difference between a shitty or a great plan? EntryRevel to the rescue again to help you decipher the health insurance jargon when it comes time for you to act like a real adult and pick your health insurance plan.

health insurance

Plan Types:

HMO: “Health Maintenance Organization.” This plan allows you to seek healthcare services through a network of providers identified by your insurance company. You have to identify a PCP (primary care physician) and be referred by that provider to any specialty services in order for the costs to be covered.

PPO: “Preferred Provider Organization.” This plan will only cover costs for physicians or hospitals listed on the insurance provider’s list of acceptable providers or hospitals. It won’t require you to work through a primary care physician, but if you see a physician out of network, they may not cover any costs at all.

Indemnity: Also known as “fee for service” plan. A plan which allows you to see any healthcare provider and your insurance will cover a set amount of the cost. Allows more freedom in picking where or who you see to provide care, but may also require that you pay the cost up front and then request reimbursement from the insurance company.

Ok, plan types, got it. But what about the other stuff? If I have insurance, why do I still have to make payments?



Co-pay: The amount your insurance provider requires you pay out of pocket for specific services rendered. Typically if you see a specialist or visit urgent care, you’ll also have a co-pay, but you’ll know up front what the cost will be.

Premium: The amount paid to the provider in order to provide coverage. Usually in monthly increments and will be covered in part by the employer, the rest by the employee. If you are covered through work, this amount is typically taken out of your paycheck before you ever see it.

Deductible: The amount you have to pay out of pocket per year before your insurance will start covering your healthcare costs. The lower this number is, the better, especially if you don’t plan on seeking a costly amount of care.

Note: Premiums and deductibles are inversely related. The cheaper your premium is, the higher your deductible will be and vice versa; so picking your plan will have to be a balance between what your monthly payments are and what services are rendered within a year.



But if you’re young and you think you’re invincible and that you won’t need health insurance, you’re wrong. As someone who works in a hospital, I will tell you the cost of anything related to healthcare is INSANE. Seriously, not only will any procedure or test run you hundreds of thousands of dollars, but they will charge you right down to the cost of the ass-less hospital gown ($10.75). If there is any risk of you ever having an illness or health complication (there is) you need health insurance. And it is so worth any seemingly wasted premium or monthly payment for your healthy years, in order to save you in any time of illness. I repeat, NOT OPTIONAL.