Equitable access to health care is important for everyone, particularly during a pandemic!
According to the American Medical Association "Marginalized and minoritized patients have and will suffer disproportionally during the COVID-19 crisis due to the inequities in society perpetuated by systematic practices."
Having health insurance is incredibly important, but for many, it is also very intimidating to acquire and navigate. Luckily, Insurance Agent, Mom, and Guest Blogger Stacy Baker, is doing some myth busting for us just in time for open enrollment.
No one wakes up wanting to be an insurance agent. It’s something we fall into! We use our problem solving skills, analytical skills, and customer service skills to help people navigate the often confusing world of insurance. It provides me a living as well as the rewarding feeling of being able to help people with something that is often mind boggling.
Let’s clear up some of the common misconceptions that I hear on a regular basis by responding to some FAQs.
Is this Obamacare? For the most part, everything is Obamacare. Which by the way is not a term I like to use. It’s slang for the ACA or Affordable Care Act which passed in March of 2010 and went into effect Jan 1, 2014. Whether it’s a group plan, or an individual plan, it’s part of the Affordable Care Act. If it’s a plan that someone had before the ACA was passed and they still have it, then it is called a “grandfathered” plan.
Is this a private plan? I’m not really sure what that means. Health insurance plans are administered through health insurance companies. Whether you enroll through Covered CA or directly with the health insurance company, it’s the same plan, same company, same benefits. etc.
Only low-income individuals apply through... [the Marketplace]. That is not true.... [The] marketplace allows people to enroll whether they are eligible for premium assistance or not. The plans that are available on Covered CA [for example] are also available directly with the carriers. There may be additional plans available through the carriers that aren’t on Covered CA, but for the most part, they are the same.
Deductible is the most important element of health insurance. NO! This one gets me. Somewhere along the line, it was drilled into people’s heads that they needed to worry about the deductible. No…what services are you able to obtain prior to the deductible being met? That’s important as well as the maximum out of pocket. This is really what matters. If you were to get sick, once you’ve met the out of pocket max (not the deductible) the carrier would pay 100%. Some plans have a 0 deductible. Does that mean the insured pays zero? No, it just means that there are no services that the deductible needs to be met first. They would still be responsible for co-pays and co-insurance that would go toward the out of pocket maximum!
I have a PPO so I can go to any doctor I want to see. Yes and no. Even if you have a PPO, it’s still best to stay in network or you could incur thousands of dollars in expenses. If you go out of network, you will need to meet the out of network deductible first and then you will be reimbursed only a percentage of what’s deemed reasonable and customary. Again, it is best to stay in network.
I am a licensed agent in California so please reach out if you need assistance. (firstname.lastname@example.org) There is no charge to use my services. Open Enrollment in California runs from Nov 1, 2020 to Jan 31 2021.
Open enrollment nationwide is from November 1 to December 15, though deadlines in your area may be extended. If you live outside of California, make sure you reach out to an insurance agent in your area to help you through the health insurance selection process.
Stacy Baker is a mom who loves music, red wine, exercise, and dachshunds! She is a licensed insurance agent in California.