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  • Writer's pictureMadilynn Beck

The Great Insurance Mystery



You've probably heard your parents talk about it, seen the commercials with smiling families, and received countless emails with perplexing acronyms – yes, we're talking about the ever-elusive, somewhat mysterious world of medical insurance. It's like trying to solve a riddle wrapped in an enigma, wrapped in a gluten-free pita, dipped in hidden fees. But fret not, there's ways to navigate it...we think.


(Also, insurance as the Insured, versus as the Provider is verrrrrry different for many reasons. This post is just for our Clients/Patients out there. Providers, you got next.)


What Is Medical Insurance, Anyway?

Medical insurance, or health insurance, is like a financial safety net for your well-being. Think of it as your secret weapon against unexpected medical bills. You pay a monthly premium, and in return, your insurance company (is supposed) to help cover the costs of your healthcare.


The Unbelievably Annoying Acronyms

When you're diving into the world of medical insurance, it can feel like you've stumbled into a cryptic acronym convention. You've got your PPO, HMO, EPO, and even some HSA sprinkled in for good measure. Let's see if we can break it down:


PPO (Preferred Provider Organization): It's like the VIP club of insurance plans and the costs are VIP too 😬. You can see any doctor you want, but it's cheaper if you stick with the ones in your insurer's network. Think of it as ordering à la carte.


HMO (Health Maintenance Organization): It's more like a Netflix subscription – you pick a primary care doctor, and they coordinate your care. You need referrals to see almost everyone, so it's like having a medical director that doesn't really take into account your timeline⏰ , but that of other providers.


EPO (Exclusive Provider Organization): EPO is like a PPO but with a much stricter guest list. You've got to stay in-network for all your healthcare needs. It's like getting access to a concert, but you can only stand in one row. No aisle. No visiting your friends in another section. No swapping tickets mid-show. You get what you get and you don't pitch a fit.


HSA (Health Savings Account): This is like a secret savings account that you can only use for medical expenses.🐖 You can think of it as a piggy bank for your health.


The medical landscape is changing as rapidly as the industry and the big wigs up top are finally seeing the need to change or be changed when it comes to access to health.


The Dreaded Deductible

The deductible is often like the entrance fee to the healthcare party. You have to pay a certain amount out of your own pocket to even enter and then once you're in everything is overpriced anyway. Once you've met your deductible, the insurance company usually chips in to cover a portion of your healthcare costs.


The Mystical Premium ✨

Your premium is the monthly fee you pay to keep your insurance policy. It's like paying rent for your health security. The higher the premium, the lower the deductible and vice versa. So, it's all about striking the right balance between what you can afford upfront and what you can handle if you need medical care. This is def more a science than an art. If the math isn't mathing, then move the needle to where it feels sustainable for you.


The Great In-Network vs. Out-of-Network Dilemma

Sticking with in-network providers is like shopping at your favorite local store – it's usually cheaper and more convenient. Going out-of-network is like shopping at a fancy boutique; it can be pricier, but sometimes it's worth it. Ask to peruse your carriers network BEFORE committing, this can save you a lot of heartache later. 🚨 REMEMBER you can only shift plans,etc. during certain times of the year.


So...in short - CHEAT SHEET ✅

Assess Your Needs: Are you a healthy, young adult, or do you have specific healthcare needs? Your lifestyle and health should guide your plan choice.


💸Check Your Budget: Be honest about what you can afford. Remember that it's not just about the premium; it's also about the out-of-pocket costs.


🛒Shop Around: Don't just settle for the first plan you find. Compare options and ask for advice. There are apps and websites to help make this easier.


🔍Read the Fine Print: Understand what's covered and what's not. Nobody wants a surprise medical bill.


🔮Think About the Future: Consider how your life might change in the next year. Are you planning on starting a family or taking up skydiving? Your plan should adapt to your evolving needs.


Remember, your health is an investment, and medical insurance is supposed to be a safety net, not a burden. It should let you live your life with confidence, knowing that you're protected against unexpected healthcare costs. Plus, it's one less thing to stress about when you're juggling your job, your side hustle, and those weekend brunch plans. If its stressin' you talk to a professional that has no skin in the game (that means no insurance sales people, but someone knowledgeable in the field- even us!)

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