Understand Health Insurance

Your health plan company may ask you to pay for some of the care you get. This is often called cost sharing because you share or pay some of the costs, and your health plan company pays the rest. There are many types of costs that you could pay. These are:

Copayment: Sometimes this is called a “copay.” This is most often a set amount you pay for a visit, test, or meds. Copays are often lower for family doctors than specialists.

Deductible: This is the amount of money you need to pay each year before the health plan group will cover all the left-over costs. It is often called “meeting your deductible.” If you are healthy and don’t use healthcare often, having a high deductible and low monthly cost for a health plan may make sense. But, if you become sick, then your costs may be higher.

Coinsurance: After you have met your deductible for the year, some insurance companies still require coinsurance. This is the percent of the cost that you will still pay for some services.

All this may not be clear. It is vital to know what the scope of your health plan offers before you sign. Call your health plan company if you don’t know or speak with your doctor for answers to your questions.

Medicare is the federal health plan program for:

• People who are 65 or older
• Certain younger people with handicaps
• People with End-Stage Renal Disease (permanent kidney failure needing dialysis or a transplant, sometimes called ESRD)

The program helps with the cost of health care, but it does not cover all health costs or the cost of most long-term care. You have choices for how you get Medicare coverage. If you choose to have Original Medicare (Part A and Part B) coverage, you can buy a Medicare Supplement Insurance (Medigap) policy from a private health plan group. Learn more here.

Medicaid gives health plans to millions of Americans, such as eligible low-income adults, children, pregnant women, older adults and people with handicaps. Medicaid is run by states, as stated by federal rules. The program is funded jointly by states and the federal government. Learn more here.

The District contracts with 3 Medicaid Managed Care Organizations (MCOs) to provide access to services for the DC Healthy Families Program, the DC Health Care Alliance and the Immigrants Children’s Program.

The current MCOs are:

• CareFirst Community Health Plan District of Columbia
• AmeriHealth Caritas District of Columbia
• Medstar Family Choice

For more information on DC programs click here.

You have the right to help decide what health care or treatment you want to get. By law, your health plan doctors must make clear your health issue and care choices to you.

Informed consent means:

• You are informed. You have received info about your health issue and care choices.
• You know your health issue and care choices.
• You can decide what health care treatment you want to get and give your okay to get it.

To get your informed consent, your doctor may talk with you about the care. Then you will read a description of it and sign a form. This is written informed consent.

Or your doctor may make clear a treatment to you and then ask if you agree to have the treatment. Not all health treatments need written informed consent.