Helping Consumers Understand How to Use Their Private Health Insurance

Transcription

1 Helping Consumers Understand How to Use Their Private Health Insurance Adam Fox Director of Strategic Engagement Colorado Consumer Health Ini;a;ve Shelby Chapman Health Literacy Program Manager Children s Hospital Colorado Jenny Santos CCARES Health Coverage Guide Servicios de la Raza

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3 Roadmap to Using Health Insurance Be#er Health Empower Pa1ents Use It or Lose Them Cost Is King

4 Use It or Lose Them GeHng them in the door Finding an in- network provider Making the first appointment

5 Use It or Lose Them Most health plans must cover a set of preven;ve services at no cost to the consumer. Image from

6 Adults Women Children Blood pressure screening Cholesterol Screening Colorectal Cancer Screening for adults over 50 Contracep;on BreasPeeding support and counseling Mammography screening every 1-2 years for women >40 Au;sm screening Depression screening for teens Developmental screening for children under 3 Diabetes (Type 2) screening for adults with high blood pressure Hepa;;s C Screening for adults at risk Domes;c violence screening & counseling Tobacco Use screening and interven;ons Hearing screening for newborns Immuniza;ons Immuniza;ons Obesity screening and counseling Cervical cancer screening for sexually ac;ve women Well- woman visits Lead screening for children at risk of exposure Vision screening for all children

7 Use It or Lose Them Refer consumers to the CDC Preven;on Checklist

8 Use It or Lose Them All marketplace plans and many other plans must cover preven;ve services without charging a copayment or coinsurance. This is true even if someone hasn t met their yearly deduc;ble. Services must be provided by a network provider.

9 Cost is King Help consumers understand the difference between preven;ve and diagnos;c care to prevent surprise charges. What is Preven1ve Care? Preven;ve care includes immuniza;ons, lab tests, screenings and other services intended to prevent illness or detect problems before you no1ce any symptoms. What is Diagnos1c Medical Care? Diagnos;c medical care involves trea;ng or diagnosing a problem you re having by monitoring exis;ng problems, checking out new symptoms or following up on abnormal test results.

10 Cost is King Test/Service/Exam Preven1ve Diagnos1c Rou1ne Chronic Care Blood Pressure Check A person with no history of high blood pressure gets a rou;ne blood pressure check to screen for high blood pressure. A person with risk factors for high blood pressure, like being overweight and smoking, visits the doctor because he or she has early morning headaches. A person with a history of high blood pressure gets a blood pressure check to be sure his or her medica;on is helping.

11 Let s Prac1ce! Case Scenario #1: A 55- year old woman no;ces a lump in her right breast and schedules a mammogram to check the lump. Case Scenario #2: A 42- year old woman is going in for her yearly mammogram to screen for breast cancer. Case Scenario #3: A 60- year old woman with a history of breast cancer is going in for a follow- up mammogram acer she had a lump removed. Preven1ve Diagnos1c Rou1ne Chronic Care

12 Let s Prac1ce! Case Scenario #1: A 55- year old woman no;ces a lump in her right breast and schedules a mammogram to check the lump. Case Scenario #2: A 42- year old woman is going in for her yearly mammogram to screen for breast cancer. Case Scenario #3: A 60 year old woman with a history of breast cancer is going in for a follow- up mammogram acer she had a lump removed. Preven1ve Diagnos1c Rou1ne Chronic Care

13 Cost is King Help consumers understand the difference between primary care and emergency care

14 Cost is King hdps://marketplace.cms.gov/outreach- and- educa;on/downloads/c2c- emergency- department.pdf

15 Let s Prac1ce! Primary Care or Emergency Care? Case Scenario #1: A forty- year old woman with diabetes needs a refill for her insulin. Case Scenario #2: A sixty- year old man thinks his foot may be broken. Case Scenario #3: Your 1 year old child has a fever and looks very sick. *Always call 911 or seek emergency care in a true emergency

16 Let s Prac1ce! Primary Care or Emergency Care? Case Scenario #1: A forty- year old woman with diabetes needs a refill for her insulin. Case Scenario #2: A sixty- year old man thinks his foot may be broken. Case Scenario #3: Your 1 year old child has a fever and looks very sick.

17 Pediatric Tool: ChildrensMD

18 Empower Pa1ents to Take an Ac1ve Role Empower Consumers to Take an Ac;ve Role in Their Health Don t be Shy Speak Up!

19 Empower Pa1ents to Take an Ac1ve Role Ask Me 3 1. What is my main problem? 2. What do I need to do? 3. Why is it important for me to do this?

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21 References Centers for Disease Control and Preven;on CDC Preven;on Checklist. hdp:// Accessed 22 September CMS From Coverage to Care: A Roadmap to Beder Care and a Healthier You. CMS Product No Accessed 22 September CMS Preven;ve Care Benefits. hdps:// care- benefits/. Accessed 22 September Families USA What You Need to Know about Health Insurance. Publica;on ID: 022NAV Accessed 22 September GuideWell Connect How to Consumer: How Will the Consumer of 2015 Shop for Health Insurance. hdps:// to- consumer- how- will- the- consumer- of shop- for- health- insurance/. October 5. Accessed 22 September Medical Mutual of Ohio The Difference Between Preven;ve and Diagnos;c Medical Care. hdps:// Individuals- and- Families/Healthy- Living/What- Is- Preven;ve- Healthcare/The- Difference- Between- Preven;ve- and- Diagnos;c- Medical- Care.aspx. Accessed 22 September Na;onal Pa;ent Safety Founda;on Ask Me 3. hdp:// Accessed 22 September 2015.

22 Health Insurance Literacy: Explaining Copays, Coinsurance, and Deduc1bles!! Some consumers= You say copays, deduc;ble, out- of- pocket max>>they hear - Signomi, ala then milao elinika. (Sorry, I don t speak greek) Keys to adult learning = contextualiza;on, relatable examples, interac;vity, and applica;on.

23 + Major Goals: Interac;ve content Contextualize terms/concepts KISS Principles (Make it less in;mida;ng & don t try to explain everything at once) Demonstrate Value of Insurance Emphasize importance of u;lizing primary care Go- to resource for individual consumers and health enrollment assisters

24 cohealth.co/covereduinfograph

25 Interes1ng ways to describe HI terms Copay

26 Interes1ng ways to describe HI terms Premium

27 Interes1ng ways to describe HI terms Deduc;ble and coinsurance

28 Interes1ng ways to describe HI terms In- Network vs. Out- of- Network

29 Bronze vs. Silver Bronze - $153/month Broken arm - $7500 You pay $6,500 to reach out- of- pocket max. Insurance covers remaining $1000 Total cost to you = $6500 Silver - $183/month Broken arm - $7500 You pay $3,900 to reach deduc;ble. You pay 40% coinsurance, or $1440 of the remaining $3600. Total cost to you = $ $360 addi;onal cost in premiums = $5700 Savings = $800

30 Bronze vs. Silver Bronze - $306/month Having a baby- $11,500 You pay $2,000 in prenatal care out of pocket. You pay $9,500 for childbirth and don t reach your deduc;ble/out of pocket max ($13,000). Your insurance covers $0. Silver - $366/month Having a baby - $11,500 You pay $2,000 in prenatal care out of pocket. You pay $5,800 to reach deduc;ble ($7,800) and 40% coinsurance, or $1480 of the remaining $3700. Insurance covers $2220 Total cost to you = $ $720 addi;onal cost in premiums = $10,000 Savings = $1500

31 Bronze vs. Be#er Silver Bronze - $153/month Broken arm - $7500 You pay $6,500 to reach out- of- pocket max. Insurance covers remaining $1000 Total cost to you = $6500 Silver - $195/month Broken arm - $7500 You pay $2,050 to reach deduc;ble. You pay 40% coinsurance, or $2180 of the remaining $5,450. Total cost to you = $ $480 addi;onal cost in premiums = $4,710 Savings = $1,790

32 Bronze vs. Be#er Silver Bronze - $306/month Having a baby- $11,500 You pay $2,000 in prenatal care out of pocket. You pay $9,500 for childbirth and don t reach your out of pocket max ($13,000). Your insurance covers $0. Silver - $374/month Having a baby - $11,500 You pay $2,000 in prenatal care out of pocket. You pay $2,100 to reach deduc;ble ($4,100) and 40% coinsurance, or $2,960 of the remaining $7400. Insurance covers $4440 Total cost to you = $7,060 + $816 addi;onal cost in premiums = $7,876 Savings = $3,624

33 Silver vs. Gold Bronze - $183/month Broken arm - $7500 You pay $3,900 to reach deduc;ble. You pay 40% coinsurance, or $1440 of the remaining $3600. Total cost to you = $5340 Gold - $230/month Broken arm - $7500 You pay $2,000 to reach deduc;ble and out- of- pocket max (in this plan they re the same). Your insurance pays remaining $5,000. Total cost to you = $ $564/yr addi;onal cost in premiums = $2564 Savings = $2776 over silver plan

34 Important considera1ons New HHS guidance on OOPM in family coverage? Embedded vs. aggregate deduc;bles Provider ;ers In- network vs. out- of network Provider contracts don t align with plan year

35 Jenny Santos

36 What has worked for you? What HIL struggles need to be addressed??

37 Ques;ons??