In the United States, the average cost of a broken leg is $7,500. A three-day hospital stay could cost $30,000. And treatment for diseases such as cancer or other chronic conditions could cost well into the hundreds of thousands, according to HealthCare.gov. That’s why having a good health insurance policy is important. It can protect you financially if you get sick or injured, while also covering the cost of important health screenings that could detect illnesses early on.
And yet, health insurance policies can be incredibly confusing. There are so many companies, prices and plans to choose from, and they seem to have a vocabulary all their own (“copay,” “coinsurance,” “drug formulary,” “explanation of benefits,” for starters).
As with all industries, when you, as a consumer, are more informed about the services you use, you can make better decisions. And when it comes to health insurance, those decisions could have an enormous impact. Below, you’ll find 10 myths and facts about health insurance. After reading the list, we hope you’ll feel empowered to be a more educated and activated patient when it comes to your own health.
Myth: If you’re young and healthy, you don’t need health insurance.
Fact: Ask anyone who’s sick, or injured, if they saw it coming. The truth is, you never know what’s coming around the bend that could impact your health at any age. When you have health insurance, you’ll be protected in case something unexpected does occur. And that’ll be one less thing to worry about during a challenging time.
Myth: Healthcare plans don’t cover pregnancy.
Fact: In the past, this was true of many individual plans. That changed, thanks to the Affordable Care Act (ACA) and today, all health insurance plans on the Marketplace and all Medicaid plans cover pregnancy and childbirth. In addition, most employer-sponsored plans cover pregnancy. With Blue Cross Blue Shield of Alabama, expectant mothers can even download the Baby Yourself app, which contains pregnancy trackers and tips, and offers one-button dialing to access a physician or nurse.
Myth: You can sign up for health insurance whenever you need it.
Fact: If you’re purchasing insurance off of the Marketplace, there is a defined period of enrollment for most people, known as Open Enrollment, which begins Nov. 1 and ends Jan. 15 for 2023 plans. There are, however, some exceptions. If you’ve had what’s called a “life event”—that is, you lost your existing coverage; had a change in your household, such as a marriage, divorce, baby or death in the family; if you change your residence or experience other qualifying events (see the entire list here)—you may be able to enroll outside of the Open Enrollment during what’s known as a Special Enrollment Period.
Myth: If I choose the least expensive premium I’m choosing the least expensive plan.
Fact: Just because the premium—which is the amount you pay each month for your health insurance—is low, that doesn’t mean you’re saving money on the plan. It all depends on the healthcare needs of the person or family that’s covered. Say, for example, a person is healthy and doesn’t need to visit many doctors; and also doesn’t encounter any emergencies, unanticipated illnesses or injuries in the calendar year. For that person, the least expensive premium may, indeed, be the best. However, for a person who sees doctors more frequently, or who needs a surgery and other treatments, a plan that has a higher premium but a lower deductible (that’s a set amount of money you must pay for eligible health services before the insurance policy begins to pay) might make the most sense.
Myth: Health insurance will cover 100 percent of my healthcare visits and healthcare costs.
Fact: Different plans have different deductibles, co-pays and co-insurance rates. Whatever the plan, you will pay a portion of healthcare costs and the health insurance provider—known as a “payer”—will pay the rest. However, if you reach your “out of pocket maximum,” that means you’ve paid the maximum amount you can spend in a calendar year, and your health insurance policy will, indeed, cover remaining allowable costs.
Myth: Because I have health insurance I can see any healthcare provider I want and my plan will cover it.
Fact: What your plan covers will depend on the plan. You can look up whether doctors are considered “in network,” for example, which means they will, indeed, be covered by your plan. But you also must consider what type of plan you have. With an HMO, for example, in order for your plan to cover a specialist, you’ll need to get a referral to an in-network provider from your primary care provider. While with a PPO, you can make an appointment without a referral and your plan will cover a portion of it, even if it’s out of network.
Myth: My plan will cover any prescription and they all cost the same.
Fact: There’s a lot of variability when it comes to prescriptions. For starters, generic prescriptions will cost less than name-brand prescriptions. And not all prescriptions are covered by all plans. Be sure and check with your plan each time you get a new prescription to find out what’s covered and what your options are.
Myth: In order for my insurance to cover a healthcare visit, I must go to a doctor’s physical office.
Fact: In recent years, telehealth has become an important healthcare offering. With telehealth visits, you can meet with a healthcare provider from the comfort of your own home, and talk with him or her via phone or computer. These kinds of visits can be helpful for physical health needs as well as mental health concerns and regular therapy appointments. Again, check with your policy to see if that visit will be covered by your plan.
Myth: If I don’t have my insurance card I can’t receive healthcare.
Fact: You can access your health insurance card via the Blue Cross Blue Shield of Alabama website or even view it/share it through our app.
Myth: If I’m not happy with my insurance policy, I can switch at any time.
Fact: Unfortunately, unless you have one of the qualifying life events mentioned earlier, or you switch jobs and your employer health insurance changes, you can’t change health insurance policies until the annual enrollment period begins again. This could be especially distressing to hear for someone who was healthy at the time of enrollment, and opted for an insurance policy with the lowest monthly premium and highest deductible, thinking he or she wouldn’t be putting the policy to use; and then that person became ill or injured unexpectedly. Again, they would need to wait to switch policies during the next calendar year.
Knowing this serves as a reminder of why health insurance is important to begin with: it protects you from financial costs related to medical care. And so often, those costs are impossible to plan for.