10 Health Insurance Myths

Health insurance has inspired many an argument at family gatherings, especially since becoming politicized. With the Affordable Care Act (ACA, also known as Obamacare) requiring every American to carry health insurance, it seems everyone has an opinion on health insurance. Many people recognize its importance in their lives; after all, you never know when injury or illness will strike. Others, however, disagree. In arguments from both sides, healthcare myths take root. We debunk 10 of the most common.
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1. I am Never Sick

This is probably the most cited reason people offer for not wanting to carry health insurance. If you enjoy general good health, that is wonderful! However, what this idea ignores, or forgets, is that the purpose of health insurance is to protect you from catastrophic illness or injury. Accidents happen at any time, to anyone, and they do not care how old you are nor whether you have insurance or the funds to afford a visit to the hospital.

Illness, also, strikes at any age. Every year, nearly 12 percent of new cancer diagnoses are in people under the age of 45. That is a general, “all cancer” percentage. Some cancers are more likely to strike people under the age of 25 than those over the age of 45. Therefore, while chronic disease is mainly the province of age, it can occur at any time.

2. Health Insurance Is Expensive

Some people believe this myth so strongly that they do not even bother looking at their health insurance options. That’s too bad, because the options available today are greater than ever before, thanks in no small part to ACA.

One of ACA’s provisions is government subsidy for consumers earning less than 400 percent of the federal poverty rate. In 2015, that was $95,400 for a family of four. The result is that nearly 80 percent of Americans applying for Obamacare qualified for plans costing less than $100 per month.

Many insurance options exist beyond Obamacare, as well. We help you determine your healthcare needs and find the right amount of insurance to make sure you and your family have coverage.

3. Health Insurance Covers You Wherever You Go

Health insurance plans include preferred providers through networks such as HMOs, PPOs, and EPOs. In this instance, “provider” means doctors, hospitals, clinics, pharmacies, and more. If you have a particular doctor or facility that you want to use, peruse your provider list carefully to ensure it includes your top choices. If not, your health insurance will not cover treatment received from that provider.

4. Health Insurance Covers 100 Percent of My Care

No. Plans come with a variety of differences in both services covered and out-of-pocket costs for the consumer. Work with your broker to determine your co-pays and deductibles, as well as exactly what services your plan includes. For example, some plans do not include prescription drug coverage, while others exclude certain prescriptions. Some plans have a high deductible but low or even no co-pays, once you reach your out-of-pocket maximum. Again, review your plan choices carefully before making your choice.

5. I Can Pay for Medical Debt over Time

Without question, the number one reason people in American file for bankruptcy is medical debt. There are so many studies proving the statistic that this entire section could be hyperlinked to studies and news reports about America’s medical debt crisis. It’s part of why the ACA passed to begin with.

Technically, this myth is true. You can pay for medical debt over time. You can pay just about any debt over time. The real question is, can you afford to? The Atlantic article linked in that first paragraph tells of a man, who had insurance, undergoing a surgery that he believed to be 100 percent covered. Then he got the bill, which included $117,000 for an out-of-network doctor added to his surgery team at the last minute. How long would it take you to pay off $117,000?

6. The Doctor Has to Treat Me Anyway

In the event of emergency, you do receive treatment. The question is, how the hospital defines “emergency.” It varies from facility to facility. In some, a broken bone is an emergency, thus you receive treatment. What about a cancer diagnosis? Is there a more serious illness? It’s the go-to choice for discussions of serious illness. Is it a medical emergency, though? The answer is, “No.”

In fact, no chronic illness is a medical emergency. What’s more, even if you were to receive treatment, that does not negate the debt owed for said treatment. (See #5)

7. I Can See Any Doctor

In the same way insurance plans cover particular facilities, they also cover a select list of doctors. In addition, most health plans have rules regarding visiting specialists. In some, you may visit a specialist as long as you’re willing to pay a higher co-pay. In others, you must obtain a referral from your primary care provider first. Check your plan for guidelines.

8. Employer Sponsored Healthcare Is Better

If you have an employer that provides excellent insurance with low deductibles and co-pays, and you regularly use that coverage, you are one of the lucky ones. The idea of employer-sponsored health insurance is a relatively new feature employers use to attract talented people. It makes sense, since larger groups of people can typically negotiate better pricing. It doesn’t always work out that way, though.

The state’s largest employer (the State itself) pays extremely high health insurance premiums considering the tens of thousands of employees included. One client learned her healthcare coverage for a family of four costs over $19,000 annually. Obviously, some people are better at negotiating premiums than others are.

Many employer plans offer a 50/50 split. If you enjoy general good health and only need coverage for catastrophic events and yearly wellness visits, you likely can find better, more affordable coverage on your own. The great thing is, looking into your options costs you nothing.

9. Health Insurance Does Not Cover Preexisting Conditions

While this used to be true, ACA put a stop to this when it went into effect in 2013. Today, no one’s preexisting conditions disqualify him or her from buying health insurance. In addition, insurers may not charge higher premiums for preexisting conditions.

10. Health Insurance Covers Anything My Doctor Prescribes

Even if your doctor orders or prescribes a treatment, your health plan may not cover it. It is always best to check with your insurer before undergoing any treatment options. For example, most plans cover only one ultrasound during a pregnancy. However, some conditions, such as preeclampsia, may cause the woman’s obstetrician to order multiple ultrasounds. In this event, an order from the doctor explaining why these tests are medically necessary may convince your insurer to cover them.

You also see this in your plan’s drug formulary, which is the list of prescriptions your plan covers. If your doctor prescribes a medication not included in your plan’s drug formulary, your insurer may deny the original prescription but offer an alternative.

Be an Informed Consumer

When in doubt, read the guidelines in your healthcare plan to truly understand what it covers. Take the time to compare plans from different providers to ascertain how much coverage you need, and shop around for quotes. It costs you nothing but may save you thousands.