Why Health Insurance Is Worth It (Health Insurance for LGBTQ Folks Ep. 1)

In this first episode of our Health Insurance training series, we'll be going over some of the top reasons that it always pays to have health insurance.

Transcript:

Picture this: you’re 26 and you’re just aging off of your parents health insurance. You work in the gig economy, so you don’t get insurance through your job, but you don’t really need it, do you? You’re young, you’re healthy, you don’t go to the doctor because you don’t need to. You get your flu and covid shots for free at a pharmacy like Walgreens or CVS. So why would you need health insurance?

Hi, I’m Ben with Out2Enroll, and this is the first episode of our health insurance series for trans folks. In this episode, I hope to convince you that no matter your age or health status, it’s a good idea to get health insurance. And there are plenty of options to suit whatever budget works for you.

So let’s get back to our scenario. You’re 26 and thriving and you don’t feel like paying hundreds of dollars a month for health insurance you’re not going to use. Then something happens and honestly, it could be anything… you drop a weight on your foot at the gym, twist your ankle on a hike, come back from a trip abroad with a mysterious stomach bug that won’t go away. Now if you can go to urgent care, it might only be a few hundred dollars, although those costs rise quickly if you need anything like an x-ray or blood test.

But if you get hurt at night - most urgent cares close between 5 and 7 - or need more treatment than an urgent care can provide, you’re going to the E.R. This is where your costs are going to skyrocket. I don’t want to tell you emergency rooms are expensive and have you not go when you need to see a doctor because you’re afraid of the cost. Always seek medical care if you think you need it. I’m hoping to convince you that you should get health insurance, because, yeah, emergency care can be costly. A few hours in an emergency room, maybe an x-ray, maybe some blood labs, a five minute conversation with a doctor, can run up thousands of dollars of bills. I’m not saying it’s right. But there is something you can do to prevent it.

And that thing is to get health insurance. Now, in this scenario, you don’t have to worry what emergency department you end up in because the affordable care act made it so that all emergency services have to be considered in network, even if you’re out of state.

But what I really want to explain is negotiated rates. This is kind of a doozy and something that I didn’t really understand until pretty recently so I want to make sure you all understand because it’s super important.

What are negotiated rates?

A negotiated rate is the amount that your insurance negotiates with a hospital or healthcare provider for every service. This is a max rate that the provider can charge you, and it’s essentially a massive discount from what they otherwise would charge if you didn’t have insurance. You can see this every time you get health care and get an EOB in the mail. We’ll go over Explanations of Benefits in a future episode, but you can see that there’s an amount charged and then in the next column (or a few over) an “allowed amount” or “plan discount”.

The insurance company has negotiated on your behalf, to lower the actual cost of service. This is even before we talk about copays or deductibles.

Why does this matter?

Well, there’s no law saying how much a procedure or service has to cost. There is a newer law that hospitals have to be transparent about their pricing and list costs on their website. And some states are trying to implement cost ceilings for private insurances. But in general, there’s no set price for how much something costs. Prices different based on any number of factors, where you are in the country, how new the equipment is, if it’s a facility with emergency services, and more.

You also pay for so many individual items which make it hard to have a set cost. In the case of an imaging test, say an x-ray, you pay for the use of the machine, there’s the person operating it, like an x-ray technician, there’s a doctor interpreting the results. These costs add up fast if you don’t have an insurance company working on your behalf to keep costs in check. If you do have health insurance, you’ll pay one single number for the entire x-ray experience, either your copay for that procedure or co-insurance which is a percentage, and we’ll go over both those terms later.

This is, in my opinion, the single best reason to get health insurance. If you think about the term insurance itself, we all pay for car insurance or insurance on a house or apartment rental and get nothing from it unless something terrible happens. What we’re getting from it is peace of mind and financial protection from being bankrupted by medical bills or struggling for years under the weight of medical debt. If you think of it this way, we’re actually getting a lot of benefits in addition to the protection from catastrophe.

What is catastrophic care?

If you’re under the age of 30 and still unconvinced, at least look into catastrophic care (or a high deductible health plan) which has much lower premiums and covers basically just these emergency scenarios. We’ll cover that more in a future video when we look at all the different plan options.

What are some other benefits of health insurance?

Aside from financial protection, another great reason to get health insurance are all the additional benefits like I mentioned. The affordable care act implemented a requirement that certain preventive services be available for free. This includes annual check-ups, preventive cancer screenings, certain birth control interventions, tobacco cessation programs, and more.

We have an upcoming episode dedicated to all the free things you can get through your health insurance. In the meantime, just know that they exist but most of these services though are only free through an insurance plan and provided by a doctor in your insurance network.

So any insurance plan will give you access to this!

Finally, many health insurances come with little perks like fitness and wellbeing app subscriptions - mine gave me access to two different meditation apps which I use daily for my mindfulness practice and for white noise when I sleep. Obviously these don’t nearly make up for the cost of a health insurance premium, but we’re going to be covering how to find affordable health insurance in the next episode.