If you were born between about 1980 and about 2000, you fall into the Millennial generation. If you were born in the earlier end of this time frame, you’re now in your mid-30s. You’ve likely had health insurance for a few years. But if you were born in the middle of the range or toward the end of it, a health plan is probably not something you’ve thought about much. Or at all.
If you were born in 1990, you’re right around age 26 now. This is the age at which you must find your own health plan, according to the Affordable Care Act. As an adult, you’re generally able to remain on your parent’s health plan until your 26th birthday. Once you hit 26, though, it’s over. Marketplace health plans let you stay on your parent’s policy until the plan year ends on Dec. 31, but job-based group health plans usually end your coverage at the end of the month in which you turn 26. Regardless of the end date, you should look into getting your own health plan before your coverage is gone.
So where do you start? What do you need to know? Healthcare.gov offers some helpful tips on how to get coverage for those turning 26. Talking to a health insurance agent is always helpful. But don’t wait—if you aren’t covered for a few months, you may have to pay a fee.
Learning the lingo
Before you can ask questions, though, you should get up to speed on the health insurance lingo. Here’s a quick rundown of some important terms you should know so that you can ask informed questions and get the answers you need.
Benefit: This is the amount payable by the insurance company for you, as a health plan member, for medical costs.
Claim: A request by you, the member, or your health care provider to get the health plan to pay for medical services.
Coinsurance: Usually a percentage, this is the amount you pay toward the cost of covered services after your deductible has been met. For example, if the health plan pays 80% of your claim, then you pay the remaining 20%.
Copayment: A flat fee for certain medical expenses that you pay while the health plan processes the rest. You might pay $50 for every doctor visit, while the insurer processes the remaining amount.
Deductible: The amount of money you must pay each year to cover eligible medical expenses before your insurance policy starts paying.
Effective date: The date your health insurance coverage begins.
Explanation of benefits: Also referred to as an EOB, this document is the insurance company’s explanation of how your medical claim was processed. It shows what the insurer paid and what is your responsibility.
Health savings account (HSA): If you choose a qualified high-deductible plan, you may want to use an HSA to help pay your expenses until you meet your deductible. This special type of account lets you pay for medical expenses with pre-tax dollars. The details can be complicated, so talk with your agent about it if you’re interested.
Network: The group of doctors, hospitals, and other health care providers that contract with the insurance company to provide services at discounted rates. You will generally pay less for services received from providers in your network.
Premium: The amount you pay each month in exchange for insurance coverage.
Provider: Any person or institution (e.g., doctor, nurse, dentist, hospital, clinic) that provides medical care.For even more terms, you can check out the website for the Wisconsin Office of the Commissioner of Insurance. There’s a glossary there that can help you with definitions and your understanding of health insurance. When you’ve familiarized yourself with the jargon, talk to your local agent or come back to our website to review some individual and family health plan options.