Dr. Corey McCarthy,
Vice President, Customer Advisory Solutions Team, Consumer Segment, Blue Cross & Blue Shield of RI
HOW INSURANCE WORKS
At its most basic, health insurance is a ways to protect you against the “risk” that you may need very expensive healthcare. From an injury requiring urgent care to a chronic illness like HIV, health plans limit your financial risk to costs you can predict, like premiums, deductibles, coinsurance, and copayments. Insurance also makes it easier to stay healthy by covering preventive care and screenings.
Regular screenings and preventive care are essential for overall health. Remember that vaccinations are critical for adults as well as children—beyond an annual flu shot and boosters, your doctor can recommend vaccinations to stop some health problems before they start.
It’s important to have a relationship with your primary care provider (PCP), so that he or she understands your history, what’s “normal” for you, and can support you and your evolving needs over time. This will help your PCP ensure that you get screened for conditions for which you might have a higher risk. Early detection can mean managing issues before they require more dramatic lifestyle changes or extensive prescription regimens, and also help reduce the risk of spreading disease. For example:
• Cancer: Breast cancer and regular Pap screenings (to detect HPV and cervical cancer) are critical for women and for trans men. HPV, the most common sexually transmitted infection in the country, often leads to cervical cancer and can spread with no symptoms.
• HIV and AIDS: As of 2011, gay and bisexual men made up an estimated 57% of all HIV-positive people in the US.
• Hepatitis C: Men who have sex with men are also at greater risk for contracting Hepatitis C, but a new cure gives hope to the estimated 3.2 million Americans who suffer from this chronic infection.
Whether you are fighting an infection, battling depression or managing a chronic condition, insurance can help you get the treatment you need to get better. Health isn’t just physical—it’s also mental. More than 7 out of 10 LGBT Americans suffer from depression, far more than 1 in 10 for the general population. If you struggle with any form of mental illness, insurance can cover both counseling and pharmacological treatments.
The right insurers can also help you find the proper care team to managing things like chronic conditions. Whether it’s following prescription regimens, making better lifestyle choices including diet and exercise, or monitoring for conditions that frequently exist together, like HIV and Hepatitis C, comprehensive insurance coverage and a strong relationship with your PCP can help you keep these issues in check.
WHAT TO LOOK FOR
When you’re looking for an insurance plan, you have two primary sets of issues to explore: cost and care. Cost considerations include everything that you might pay for, as well as other benefits that can save you money:
• Monthly premiums: the cost each month for health insurance coverage
• Deductibles: how much you pay first, before insurance begins to share the cost
• Copays: how much you pay for certain services and procedures
• Wellness Benefits: Programs and incentives like reimbursements for fitness center memberships
It’s important to understand that plans with higher co-pays and deductibles sometimes have lower monthly premiums, intended to provide incentives for you to focus on wellness, prevention and limiting unnecessary medical expenses. There’s no one “best” plan—the right choice for you will depend on your personal health and risk factors.
Care considerations center on issues related to the network of care providers to which your insurer will give you immediate access. It’s critical to find a PCP you trust, so that you can be completely honest and give them a realistic understanding of your lifestyle, risk factors, and any other potential health issues.
New advanced care networks put the patient at the center by offering more integrated and coordinated care. These care networks are structured to increase collaboration among all members of the healthcare team—including doctors, hospitals, nurse practitioners, technicians, pharmacists, dentists, therapists and others—and new health plans require and incentivize teams to meet high quality metrics and achieve better outcomes for patients. When all members of healthcare teams coordinate and share the same information, everyone understands the “big picture” of your health and needs.
Open enrollment for individuals and families (mid-October through December 7th) is the time each year when you can choose a new health plan regardless of other qualifying changes. You can buy insurance in several ways: through your employer as part of a “group plan;” directly from the insurer, whether on their website, over the phone, or in-person at a retail location like BCBSRI’s Your Blue Stores; through the state exchange, HealthSourceRI; or, if you’re eligible, through federal Medicare or state Medicaid.
No matter how you shop for insurance or what plan you choose, the most important step is using your coverage once you have it. Don’t wait until you “need” it—the best care team can’t keep you healthy if you don’t show up.