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Insurance 101: Plans &
Insurance can be complex—we get it. It’s important to learn about the options available so that you can make a decision that’s right for you.
Note: Eligibility for insurance plans is varied. You may not be eligible for every insurance plan mentioned in this guide.
I interned for a small start-up when I was still covered by my parents’ insurance plan, which gave me the latitude to choose companies of different sizes…it was an awesome experience and one that I would have loved to have gone and done post-college. But to have the best opportunity at good health insurance coverage, being at a big company was a big benefit of that.”
–John, tech worker living with cystic fibrosis (CF)
Understanding health insurance
Health insurance comes in 2 main categories: commercial and government-funded insurance, each with their own sub-types. Here’s a closer look at each type.
A group plan is coverage provided by an employer or union. You may be familiar with some commercial health insurance companies. Some examples are Aetna, Blue Cross Blue Shield, and UnitedHealthcare. Remember: If you are 26 years old or younger, it may be possible to be included on a group policy from your parent or guardian's employer
With individual plans, you purchase coverage directly from a private insurer or through the Health Insurance Marketplace (sometimes called the Health Insurance Exchange). The Marketplace, created as part of the Affordable Care Act, provides coverage to people who don't have access to a group-based plan, and don't qualify for Medicare or Medicaid. For more information about Marketplace plans, visit www.HealthCare.gov
What are co-pay adjustment programs?
Co-pay adjustment programs are programs that do not count co-pay assistance towards your deductible, out-of-pocket costs, and/or out-of-pocket maximum. This co-pay assistance includes co-pay cards and traditional coupons provided by manufacturers.
Identifying co-pay adjustment programs
If you rely on manufacturer co-pay assistance programs, it is important to understand whether your insurance plan uses one of these co-pay adjustment programs and assess how you may be affected. These programs can have names like Accumulator Adjustment Program, Variable Co-pay Program, Coupon Adjustment: Benefit Protection Program, or Out-of-Pocket Protection Program, and are not always easy to identify.
Here are some tips for identifying these programs:
Review the Explanation of Benefits (EOB) section of the insurance plan. This will outline how your deductible and out-of-pocket maximum are met
Search the insurance plan’s Schedule of Benefits or Pharmacy Limitations and Exclusions for keywords, such as coupon, co-pay card, manufacturer, and discount, to determine if there are any written restrictions for the co-pay assistance you may receive from manufacturer co-pay assistance programs
Call your health plan and ask them directly how manufacturer co-pay assistance is applied or accepted
Medicare is the federal health insurance program not just for people who are 65 years old or older, but also for certain younger people with disabilities and people with end-stage renal disease. For more detailed information about Medicare coverage, visit www.Medicare.gov
Medicaid is a joint federal and state program that helps with medical costs for some low-income adults, children, pregnant women, elderly people, and people with disabilities. It covers:
- Free or low-cost healthcare for low-income individuals who qualify
- Inpatient and outpatient hospital services, doctor visits, nursing home and home health services, and lab and X-ray services
- Prescription drugs
Be sure to check your state’s eligibility guidelines for Medicaid before buying an individual plan. Keep in mind that some states may place limits on medicines. Visit www.Medicaid.gov to find out more detailed information about Medicaid and your eligibility
People who are dual-eligible are enrolled in both Medicare and Medicaid at the same time. Dual eligibility allows for more comprehensive coverage and typically applies to those with significant medical needs. Medicaid does not pay for services covered under Medicare. Medicaid coverage only goes into effect after Medicare, employer plans, or Medigap plans have been applied
If you don’t have health insurance, ask the social worker if there are any programs that might help you pay for care. These could include grants to pay for medications, or cash-pay discounts for appointments.
Travel insurance is an important consideration for any traveler, but it is even more important when you have CF. Travel insurance can protect you in the case of:
Trip cancellation or interruption. If you’re feeling unwell and need to cancel your trip outright or change your plans mid-trip (for example, changing to an earlier flight), this type of insurance can reimburse you for any cancellation fees or additional charges that you might encounter
Lost luggage. This type of insurance often provides you with a cash payout to help you replace any checked item that is lost, misplaced, or damaged by the airline. If you’re planning on checking bulky medical devices, this might be especially important
Medical emergencies. Your health insurance plan may still be valid while you’re traveling, but it’s important to check exactly what is covered. For example, your plan may cover local treatment, but not the costs of getting you home to your own CF care team. You can also purchase supplemental travel health insurance if your regular plan is not enough
Travel insurance is often included as a perk of certain credit cards, but be sure you read the fine print to understand exactly what is covered and if it fits your needs.
Life insurance is available in different forms, but generally provides a lump sum of cash in the event of your death. This could be a small amount intended to cover funeral costs, or a larger amount that can support your family for a longer period of time. While some types of traditional life insurance require a medical assessment and can exclude those with a chronic condition like CF, there are other types (for example, “guaranteed issue”) that can be purchased without any medical questions.
No matter what kind of insurance you’re looking for—be it health, travel, or life insurance—the most important thing you can do is ask lots of questions and be sure you understand your plan.