Tips for understanding health insurance basics

Tips for understanding health insurance basics

A student standing at the Apothecary Pharmacy checkout counter with a prescription medication and his insurance card.

Health insurance is probably one of those things you wish you would’ve learned about in high school or as part of your undergraduate degree. While insurance plans can be complex, understanding your policy is an important part of managing your health (and wallet).

If you feel overwhelmed navigating healthcare or insurance systems, you’re not alone. That’s why we’re here to help. Here are a few tips and tricks to help you understand the basics and make the most of your health insurance plan.

Did you know?

All CU Boulder students can access care through Medical Services, regardless of what kind of insurance plan they have. This includes students with the Anthem Gold Student Health Insurance Plan (SHIP) as well as private insurance plans.

Why is health insurance important?

Health insurance helps cover the cost of medical treatments, appointments, mental health visits, prescription medications and other health-related expenses. Like car insurance, health insurance can provide us with a sense of security in case accidents or unexpected illnesses or injuries happen.

While you may have your own private health insurance plan, many students choose to enroll in the Anthem Gold Student Health Insurance Plan (SHIP) designed specifically for CU Boulder students.

Important insurance terms to know

It’s important to know that every health insurance plan is unique. The “rules” for your insurance plan may be different from that of your friends. Here are a few important terms to know and look out for to help you understand and use your health insurance:

  • Premium: This is the amount you pay in order to be part of a health insurance plan. If you are on a family member’s insurance plan, they are likely the one who is paying the premium. If you choose to enroll in the Anthem Gold Student Health Insurance Plan, your premium ($1,988) is paid through your tuition account once per semester.
  • Deductible: This is the amount you pay for services each year before the insurance company starts paying its share of the costs. For instance, students with the Anthem Gold SHIP have a deductible of $500. This means that you are responsible for paying the first $500 worth of care you receive. After you’ve paid the full $500, your insurance company will start helping to cover expenses. Some insurance plans are considered high deductible plans, where the deductible can range anywhere between $5,000 and $10,000 per year.
  • Copay: A copay is a fixed amount that you pay upfront when you receive care. Copays can apply to appointments, prescriptions or other services. Sometimes copays count toward your deductible amount, but not always. For instance, students with the Anthem Gold SHIP have a $40 copay that does not count toward their deductible.
  • Coinsurance: Coinsurance means that you pay a percentage of the total cost of your medical care. For instance, students with Anthem Gold SHIP have a 20% coinsurance that starts after their deductible is met. This means that if you get an x-ray for $100, you would pay $20 and your insurance company would pay the remaining $80. Coinsurance typically applies to major medical services or expenses, like imaging, surgery, etc.
  • Out-of-pocket expenses: This term describes all of the costs you pay for yourself. For instance, if you pay the cashier at the pharmacy or the receptionist when you check in for an appointment, these are considered “out-of-pocket expenses” because they are coming out of your own wallet.
  • Out-of-pocket maximum: Most plans put a maximum limit on the amount of money you have to personally pay for medical expenses. For most plans, the limit can range from a few thousand dollars to tens of thousands. For instance, students with the Anthem Gold SHIP have an out-of-pocket maximum of $8,750 per year. After you meet this amount the insurance plan pays 100% of any additional medical expenses you incur. If your plan uses copays, they may or may not apply to your deductible, but they will count toward your out-of-pocket maximum.
  • In-network/out-of-network: Most insurance plans partner with doctors to get better pricing and coverage for health services. Doctors and health centers that are partnered with your insurance plan are part of an “in-network” group. Doctors and health centers that are not part of this group are considered “out-of-network”. Out-of-network services usually have a separate deductible and out-of-pocket maximum that is higher than your in-network deductible/maximum. Because of this, out-of-network services often cost more or may not be covered by your insurance plan. Researching doctors, hospitals or other providers in advance can help you save money and avoid surprise bills. For students with the Anthem Gold SHIP, you have access to a very broad Anthem PPO Network.
  • Supplemental coverage: Insurance plans don’t always cover everything. Supplemental coverage is designed to help cover the bills and costs that your insurance plan doesn’t pay for. CU Boulder has its own supplemental coverage program known as BuffCare. This plan is available for students who choose to use their own private health insurance plan at CU Boulder. BuffCare is designed to give you peace of mind in the event of an illness or injury by covering out-of-pocket expenses for care provided by Medical Services.

How to read your insurance card

Insurance cards are unique for each insurance company and plan. However, many of them provide similar information, regardless of what kind of insurance you have. Here is an example of what an Anthem Gold SHIP card looks like.

http://colorado.edu/health/health-insurance-basics