Open enrollment. Deductible. Coinsurance. HMO. Indemnity plan. If you’re listening this far, you probably have a migraine already. Understanding the language of the health insurance industry, let alone selecting a health insurance plan, can be confusing, frustrating, and disheartening. But never fear - we are here to give you a crash course on everything you need to know about your insurance plan. No need to scroll through Healthcare.gov’s Health Insurance glossary and risk throwing yourself out the window…

We want to give you some tools here to understand what you’re choosing when you pick a healthcare plan, but no one but you really knows what’s best for your health, so (for better or worse) we aren’t going to give any actual advice here about what healthcare plan to pick. 

Also, all health insurance kind of sucks, so you will probably get screwed no matter what you pick. Basically, we’re going to try to decode all the mystifying language that the insurance companies use to disguise the ways they’re going to screw you so at least you’ll be able to anticipate how you’ll get screwed.

https://www.youtube.com/watch?v=32vw4LZpelA

Show Notes

Names

Whether you get health insurance offered by your employer, or you have to buy insurance on your own in an exchange or on healthcare.gov, or you have Medicare and you are looking at one of the privatized Medicare Advantage plans, you’re going to be choosing from a series of plans that have totally incomprehensible names and acronyms, so let’s start by breaking down the how the name of the plan itself will tell you something about how your insurer is going to screw you.

Generally the first part of an insurance plan’s name will be the name of the insurer (like “Blue Cross” or “United Health”), then you MIGHT get a word that says who is paying for the insurance plan (if it’s a “Group” plan that means an employer is paying for it, an “Advantage” plan is a privatized Medicare plan), and finally there will be an acronym that only 0.005% of people in America understand - and those are the generally people making money from the plans. These acronyms will be something like HMO, HSA, PPO, EPO, or my personal favorite “GTFO” - the “get the fuck out of here that can’t be a real plan” plan!

Indemnity Plans (“Open Choice” or “Open Network” plans): are the opposite of managed care; you could use any doctor or hospital, there are no networks, no review of care or pre-approvals, no claims denials. These were the plans that virtually everyone had prior to the 1980s, and plans that virtually no one has today except maybe the extremely wealthy. In 1978, 95% of people had indemnity plans, then that dropped to 71% by 1988, and by 1998 it was down to 14%. Today, only 1% of workers have indemnity plans.

Indemnity plans are the opposite of managed care - you can see any doctor or hospital you want, there Today, you probably wouldn’t even want an indemnity plan, because the modern versions usually only pay a percentage of the cost of your care, leaving you with the rest and massive bills.

Health Maintenance Organizations (HMOs) represent only 12% of insurance plans today, so after taking over in the 1990s, old school HMOs are going the way of the dinosaurs. HMOs usually limit coverage to doctors/providers who work for or contract with the HMO (“in-network”). It generally won't cover out-of-network care except in an emergency. HMOs can also be limited by location, meaning you might have to live or work in a certain area to be eligible. 

Exclusive Provider Organizations (EPOs) are a new catch-phrase that are appearing more and more often, but they are VERY similar to an HMO, and you should think of them the same. In fact, that survey that only 12% of workers have HMO plans includes EPOs under the same category. EPOs often have larger networks than HMOs, and unlike HMOs, they don’t require referrals to see specialists - as long as the specialist is in their very limited net...