Birmingham young adults: What you need to know about health insurance

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A tale as old as time: You’re excited to turn 26 in a few weeks, with the nagging voice in your head (probably your parents) reminding you to get on your own health insurance plan.

It’s the reality for me and many of my coworkers right now, but it doesn’t have to be scary! We’re here to fill you in on all the basics: including terms you need to know, what to expect on a doctor’s visit and more helpful tips.

Where do I start?

My biggest question regarding health insurance plans: “How do I even begin?” And I’m not alone, either. I asked my coworkers in the same boat if they were confident in choosing a plan on their own, and they both responded with an overwhelming “no.”

A few questions I had that I’m happy to help break down for you:

• What is the difference between HMO and PPO?
  • HMO: Health Maintenance Organization provides coverage through a specific network of doctors, providers + hospitals
  • PPO: Preferred Provider Organization offers flexibility by allowing you to see any doctor or specialist, whether they are in the plan’s network or not
• What’s the difference between the categories of plans?
  • If you’re buying a health insurance plan on the marketplace (not through your employer), different categories cover a certain average percent:
    • Gold: 80%
    • Silver: 70%
    • Bronze: 60%
• What should I know about open enrollment? Pay attention here, because there are limited windows to make things happen:
  • Open enrollment for a Medicare or Medicare Advantage plan: October 15-December 7
  • If you’re purchasing a plan from the marketplace: November 1-January 15
  • If you’re on a plan through your employer: Open enrollment could happen at different times

Breaking down the costs

It’s a myth that health insurance covers everything. While your policy definitely helps, you’re still responsible for certain payments.

Here are some of those costs:  

• Premium: The amount you pay monthly for your health insurance
• Copay: A set fee you pay for a certain healthcare service
• Deductible: The amount you pay for eligible health services in a year before your insurance policy begins to share costs
  • Example: If your deductible is $1,500, you’ll pay for eligible costs for up to $1,500 before your policy helps pay for covered services.
• Coinsurance: The portion of the cost for healthcare you’ll pay after you’ve met your deductible.
  • Example: If your coinsurance is 20% and your bill is $100, you’ll pay $20 + your insurance will pay the rest.
• Out-of-pocket maximum: The most you will pay in a year for eligible health services. After paying this amount, your insurance policy covers all other services.

Don’t just use health insurance when you’re sick—put it to work!

It’s expected to use your health insurance when you’re sick, but it’s important to take advantage of it when you’re feeling well, too.

Here are a few ways Blue Cross and Blue Shield of Alabama (BCBSAL) advises you do that:

• Establish a relationship with an in-network primary care provider. This will be the point person for your healthcare needs. 
• Book an annual wellness visit. Many health insurance plans cover the cost of a yearly checkup.
• Get preventive care services. Many plans cover preventive care services like tests for high blood pressure + diabetes, vaccinations, screenings and more.
• Learn about your mental health benefits. Read about the mental health coverage your plan offers.
• Follow your formulary. A formulary is a preferred list of medications that your health plan covers.

Trust me, I know it can be overwhelming. But if I can do it, you can do it, too! Plus, there’s plenty to do here in Birmingham to help stay mentally and physically healthy.

Learn more at Blue Cross and Blue Shield of Alabama.

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