Do You Know Your Health Plan Better Than the Average New Yorker?

By Sally Poblete, Founder and CEO, Wellthie

Open enrollment is underway and more individuals and families are purchasing insurance than ever before. But enrolling in a health plan doesn’t necessarily translate to knowing how to use it. If you find your health insurance complicated and the terminology overwhelming you’re not alone: a recent study found that the vast majority of 19-30 year old adults are unable to calculate the costs of their health plan while only half could define the insurance term “deductible.”

Wellthie, a digital health care company, engaged New Yorker’s on the street about their health insurance, quizzing them about their premium, deductible, copay and coinsurance, and their network type.

How did the average New Yorker do? Take a look:

Now that you can enroll in a health plan, take advantage of your coverage by understanding what it offers you. Quiz yourself with the terms defined in the video above, and test yourself by seeing how it applies to your health plan:

  1. Premium: the amount you pay per month for health insurance coverage
    Example: Most individuals will pay a premium under $100 per month for their marketplace health plan thanks to tax credits.
  2. Deductible: the amount you’re responsible for paying before your insurances starts paying for health services.
    Example: The average 2015 marketplace deductible for a silver plan was $2,563, meaning you would need to spend $2,563 on health care services until your insurance pays.
  3. Copay: a flat fee you pay for medical services.
    Example: Since in the Affordable Care Act passed, preventive services have a $0 copay. So now you can get your flu shot at no cost!
  4. Coinsurance: the percentage of the bill you pay for medical services
    Example: If your plan details say that you have 30 percent coinsurance on visiting a specialist, your insurance will pay for 70 percent of the visit’s cost. It pays to shop around for the best value (price and quality) from health care providers.
  5. HMO: Health Maintenance Organization, a type of plan that limits coverage to care from doctors who work for or contract with the HMO.
    Example: HMO’s, like Kaiser Permanente, generally do not cover out-of-network care, but consumers save money when accessing these providers.
  6. PPO: Preferred Provider Organization, a type of plan that contracts with medical providers to create a broad network. Benefits are available in and out of network, but you pay less to use the contracted in-network providers.
    Example: A PPO is generally the least restrictive type of plan since you have a broader choice of doctors you want to see, but they often come with a higher premium.

If you have yet to renew or enroll in a 2016 health plan, visit EmblemHealth’s Affordable Care Advisor or compare your options at New York State of Health.

Wellthie is a health care technology company offering software-based solutions that help simplify health insurance.