Adult IQ — Health Insurance in America

Understand Your Coverage • Know Your Costs • Ask Better Questions

Health insurance is one of those things most people have to deal with, but very few people are actually taught how it works.

You may have health insurance through your employer, buy your own plan, have family coverage or qualify for a government program. Whatever your situation, understanding the basics can make a big difference when you're trying to work out what you're covered for and what you're actually going to have to pay.

Health Insurance in America is designed to make the U.S. health insurance system easier to understand. It breaks down the terminology, costs, coverage options and processes that can otherwise feel confusing and overwhelming.

What You'll Learn

Inside this handbook, you'll learn how to:

• Understand how health insurance generally works in the United States

• Understand employer-sponsored health insurance

• Learn about individual and family health insurance plans

• Understand Marketplace coverage and other common coverage arrangements

• Learn about government health insurance programs

• Understand premiums and what you're paying each month

• Understand deductibles, copays and coinsurance

• Understand out-of-pocket maximums

• Learn how provider networks work

• Understand in-network and out-of-network care

• Learn how prescriptions and prescription coverage can work

• Understand preventive care and other covered services

• Understand referrals and prior authorization

• Learn how claims generally work

• Understand an Explanation of Benefits (EOB)

• Recognize common health insurance terminology

• Compare plans beyond simply looking at the monthly premium

• Identify potential out-of-pocket costs

• Know what questions to ask an employer or insurance company

• Understand the importance of reading your plan documents

• Keep useful insurance and medical records

• Understand what to do when a claim is denied or a bill doesn't look right

• Know where to look for additional information or assistance

What This Book Is Really About

Health insurance can be confusing because there are so many different parts to it.

A plan may have a monthly premium that looks affordable, but that doesn't tell you the whole story. You also need to understand deductibles, copays, coinsurance, networks, coverage limits and the amount you could potentially have to pay yourself.

That's why looking at the bigger picture matters.

This handbook isn't about telling you which health insurance plan you should choose. It's about helping you understand the information in front of you so you can ask better questions and make decisions based on a clearer understanding of what you're actually getting.

When You Get the Bill

One of the most frustrating parts of health insurance can be receiving a medical bill and not understanding why you owe the amount shown.

Learning how claims, insurance statements and Explanations of Benefits work can help you make more sense of what happened between receiving medical care and receiving a bill.

If something doesn't look right, understanding the process can also help you know what questions to ask and who you may need to contact.

When Your Circumstances Change

Health insurance can change when you start a new job, leave an employer, get married, have children, change your income or experience other major life changes.

Knowing what questions to ask and what information to review can help you avoid making decisions based only on the monthly cost.

Build Your Adult IQ

Health insurance is a major part of adult life and, for many people, a significant household expense.

You don't need to become an insurance expert. But understanding the basics can make it much easier to have conversations with employers, insurers, healthcare providers and other professionals.

Adult IQ — Health Insurance in America gives you practical knowledge to help you understand your coverage, recognize the costs involved, ask better questions and feel more confident dealing with a system that can otherwise be difficult to navigate.

Disclaimer

This handbook provides general educational information about health insurance in the United States. Coverage, costs, eligibility, benefits, networks and requirements vary by plan, insurer, program and individual circumstances and can change over time. It is not medical, insurance, legal or financial advice. For questions about your specific coverage, contact your insurer, employer, healthcare provider or an appropriate qualified professional.