Get Healthy Carson City: Health insurance – a primer

This column appears in the Nevada Appeal Wednesday health pages. It addresses topics related to the health of our community.

Thanks to the Affordable Care Act, many Americans who didn’t have health insurance are now covered. Seventy-five percent of Nevadans under age 65 have reported they are insured. However, most people still find health insurance to be confusing. During this open enrollment period, Carson City Health and Human Services wants to help our community understand the basics about health insurance so you can make the best decision about which plan to choose for yourself or your family. Health Insurance is a complex topic, and we won’t be able to cover every detail of every plan, but can provide insight, leading up to the deadline for enrollment on Jan. 31. We’ll try to explain some of the key “things to know” about health insurance. This week we’ll explain the basic types of coverage networks.

First, it’s important to understand health insurance doesn’t work the same way as auto or homeowners insurance. Many people are familiar with the fact if you make a claim on your auto or homeowners insurance, your premiums go up and it costs more.

Because of this, it may not be a good idea to use your auto or homeowners insurance for minor things. Health insurance isn’t like this. Going to the doctor for “minor” things, like preventive care, doesn’t make your premiums increase. In fact, it’s best for everyone if you go to your provider for preventive services, like screenings and vaccinations, which are covered at no cost to you. Having an annual check-up and being up-to-date on routine vaccinations can prevent more serious illnesses down the road. Check your plan to see what preventive services are covered free of charge.

There are different types of health care plans. Your carrier may provide one or more of these types, and it’s up to you to decide which best fits your needs. While the cost of a plan is one consideration, it’s also important to think about other things. What doctors can you see in the network? Can you visit a specialist without a referral? Do you have any conditions that might require specialized care that might not be available in the network? While the list below is not inclusive of all types of health plans, these are some common types you might encounter.

A Health Maintenance Organization (HMO) is a type of health insurance plan that usually limits coverage to care from doctors who work for a contract with the HMO. It generally won’t cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness. HMOs may have lower premiums, but usually offer less flexibility with regards to where you can go for care and what doctors you can see. A Preferred Provider Organization (PPO) offers a type of health plan where you pay less if you use providers in the plan’s network. You can use doctors, hospitals, and providers outside of the network without a referral for an additional cost. The premiums may be higher for PPO networks, but, because you can see out of network providers, it may be worth considering, particularly for those who have to travel to see specialists for rare or complex health conditions. A Point of Service plan (POS) is sort of a hybrid between an HMO and a PPO. You pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. POS plans require you to get a referral from your primary care doctor in order to see a specialist.

Next time, we’ll explore the levels of plans offered on the health exchange, and the meaning of some common, but confusing health insurance terms that can have a big impact on the out of pocket costs of your health plan. To learn more about health insurance coverage, visit www.nevadahealthlink.com or www.healthcare.gov. For more information about other Health Department services, check out our website at www.gethealthycarsoncity.org or visit us at www.facebook.com/cchhs.