Insurance 101

So, insurance. What to say about insurance? Can’t live with it, can’t toss it out a window and see it shatter into a thousand pieces on the sidewalk below? At least the (figurative) sound would be satisfying.

Diabetes is one of the most enduringly expensive conditions on the planet. The insulin pump I wear costs more than twice the average price for an engagement ring, and test strips can cost more than $1.50 each. I use between 6 and 10 per day. I’m sure your condition isn’t far behind. The bottom line is, unless independently wealthy, chronic patients can’t live a healthy life without insurance.

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According to the Kaiser Family Foundation (KFF), the nearly half of the population depends on employer-provided insurance. Most of us are familiar with that narrow timeframe known as “open season” during which you are supposed to examine all of the options and make the best choice for your family and your budget. Missing the deadline can mean a loss of coverage. It’s certainly apt that the term is also used by hunters in this country. I always feel like I am under pressure and if I can just make it through the two weeks with the right decision in hand, I will be ok. At least for the next calendar year.

But first we’ve got to get there. How does health insurance even work, and how do they come up with all these different plans? What is the difference between a Health Maintenance Organization (HMO) and a Preferred Provider Organization (PPO)? Which is right for me? Do I need separate Vision and Dental coverage? Should I use an HSA or FSA? What is different in the Formulary this year? Why is drug coverage through a separate company? What qualifies as In-network vs. Out-of Network? How likely am I to hit my out-of-pocket maximum and what counts toward it? Is there a different out-of-pocket maximum for out of network coverage?

Those are just some of the questions you face every year. They are a headache for seasoned veterans, nearly impossible to decipher for newbies. Hopefully, as I am able to do research and post more often, I will be able to help you demystify and provide answers to your questions.