Health Insurance Terms You Need to Know (in the U.S.)

let's start with a breathing exercise okay in through the nose and out through the mouth today we're getting into a calm frame of mind because we're going to talk about health insurance health insurance can be a super confusing and frustrating thing to deal with but it's a huge part of adulting since we don't have a crystal ball for how the future of American healthcare will turn out we won't be talking today about what kind of public or private health care plan options might be available to you instead this will be a primer on the very basics of health insurance for an individual regardless of where your insurance is coming from now what the next time you're choosing a plan or someone asks you how it works it won't all seem like some alien language first up let's talk about your insurance policy that you'll buy from your health insurance company this is the plan that says how much you're paying and what kind of services the insurance company will pay for including routine checkups and emergency care insurance policies usually last for one year and you'll typically sign up for a new one around December or January unless your employment or life changes many health insurance policies exclude dental and vision coverage so you'll need to buy an additional policy to cover those things if you have a eyes and teeth when choosing your insurance policy it's really important to understand how much you our premium will be the premium is how much you pay each month for the service that's just like Netflix if you get your health insurance through your company they might automatically deduct the payments from your paycheck if you signed up for a plan through the Affordable Care Act or a private insurer you are in charge of remembering to pay the premium each month how much your premium costs will be largely related to your deductible the deductible is how much you have to pay for your health care before the insurance company will start reimbursing claims the bill for the service usually the doctor's office or the hospital that you went to will send the claim aka the bill directly to your insurance company if your deductible is high like say six thousand dollars that means you'll have to pay out-of-pocket for six thousand dollars worth of services before your insurance kicks in and starts reimbursing claims but even if you haven't met your deductible most insurance plans do cover almost all of the costs of routine preventive care like getting a yearly checkup or a gynecological exam pretty much every plan though defines routine care differently so it's a good thing to read up on when picking a plan they make it really confusing the type of health insurance company you're buying a plan from might make a difference when it comes to choosing which doctors you can see if you've ever heard of HMOs aka health maintenance organizations they only cover procedures performed by certain professionals in a network you want to make sure that the doctor you go to is in-network for your HMO but wait if your health insurance comes through a PPO or a preferred provider organization that means that they'll cover your doctor visit at different rates depending on if that doctor is in network or not whether you get your health insurance through an HMO or a PPO make sure you know whether your doctor is in network and prepared to shell out accordingly if it's hard to figure out by googling you can usually call a doctor's office and ask them if they can work with your insurance plan after you sign up for a health care plan the company might require that you choose a primary care provider what you we made a whole entire video for this already when you go to a clinic or a hospital for any kind of care you might need to break out your wallet or a co-payment which is a fixed amount expected to be paid to the doctor's office when the service is rendered so let's say that you spent enough on health care this year that you meet the cutoff for your deductible awesome insurance will cover everything now right well not quite you might still need to pay in coinsurance on any additional doctor's visits for that year coinsurance is usually a percentage of the bill not a fixed amount health insurance companies sometimes describe it as your share of the cost of the health service because yeh don't we all love sharing so you can go on about how help there works for a ridiculously long time but ultimately the most important thing to understand about your health insurance plan is as much as you probably don't want to pay attention health insurance is weird and complicated in the companies themselves do not always get everything right and mistakes can happen when it comes to billing for claims read your plan when you sign up read the bills when they come in and make sure that your insurer is covering everything they're supposed to pay for if you go to the doctor and then suddenly get a bill for a service you thought was covered do your research and be prepared to fight for what you deserve the best way to resolve a conflict over an insurance bill is usually to call up the company and ask for a real live human to help you solve the problem politeness goes a long way when dealing with insurance companies and remember breathe deeply you got this thank you for joining us and if you want to learn more about adulting with Rachel and me you can subscribe to how to adult at slash learn how to adult and if you liked this episode and want to support this channel consider becoming a patreon patron at forward slash how to adult meditation guided sleep meditation with Hank Hanks arm my arm talks to you about sleep it would be really hard to send that to you in the mail you can't have my arm anyone let's do this thing couple my legs fall off eventually this is not comfortable anymore deep pretzel deep principle have ibm's new supercomputer yes read your plan read your plan when you sign up read your plan it's too long


  1. Thanks for this. You confirmed that I cannot afford to get health insurance 😂… so yeah… but really thanks because I was so confused.

  2. Hey could you guys to a video on what we need to know about President Trumps tax reform? I have been looking for objective videos on information but have failed to find. Everyone is so extreme and looking for information is becoming overwhelming! I just want to understand without claimsmakers sharing their bias on both sides! Hope you guys can help!

  3. Thank you so much for this! I aged out of my parent's health insurance plan, and applying for my own is so confusing!

  4. OR instead of needing to know this bullshit, we could switch to a single-payer style medicare-for-all system

  5. Could you guys do a video about how to correctly go to the movies? My sister always does some mystical stuff before we go, having us end up with reserved seats, snacks(usually taken from a convenience store), and popcorn/drinks, all to a movie that is having its first showing. She's too busy for me to ask, but I want to know her ways.

  6. This won't last I'm sure, but zero downvotes! And on this subject no less! That's a pretty good sign 🙂

  7. I recently got a "real job" and came off my parents' health insurance… two months later spontaneously ended up in the ER and hospital for almost a week. Now it's been just over a month since and I'm getting all these bills because the hospital gave me out of network doctors, even though they were aware of my health insurance information. So now I have to appeal and repeatedly fight my insurance provider to help me… main takeaway from this experience is that human beings should not have to worry about choosing being getting needed medical attention and being in debt forever. Free healthcare for all!!! I'm glad this video is out, I had to figure this stuff out the hard way haha

  8. I always start polite-but i have had certain times that screaming profanities into the phone is what got me results after months of getting nowhere….refusing to hang up until the problem is resolved can work too….they usually arent allowed to hang up on you…

  9. There are actually 2 other types of providers that you may find yourself with that weren't mentioned here:

    -Exclusive Provider Organizations (EPOs) are similar to HMOs in that they usually only allow for in-network providers, and may even be more selective in their provider choices. However, unlike HMOs, they don't usually require referrals to go see specialists – you can choose to visit an in-network specialist at your own discretion instead of needing your doctor to prescribe the specialist after an examination. So although you might have fewer options overall, your ability to exercise those options is far greater.

    -Point of Service (POS) plans can be thought of as kind of hybrid HMO/PPO plans – though they still require in-network providers for most of their benefits, they'll provide a little bit of coverage for out-of-network providers and specialists if used (though you'll still be eating a greater share of the costs, naturally).

  10. wow, as a canadian, this is so interesting…. like why would a country 10x as big as my own have such a basic human right so convoluted and complicated?

  11. What happens to the healthcare of uninsured people in a terrorist attack. Do they have to pay more for ongoing treatment,than the friend standing next to them with insurance?

  12. I'm 18 and this terrifies me more than taxes and car payments. Guess I'll just exercise and stay fit and go to the doctor once I'm 30 or almost die

  13. Inb4 citizens of every other industrialized nation mocking the U.S. for its rapacious, for-profit based healthcare system.

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