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Understanding Health Insurance Plans: Interview Insights

Insights from the Interviews


For this discussion I decided to question a co-worker.  I taught that maybe she could enlighten me about the insurance plan we both hold.  It was known to me that her insurance was provided by her employer. The first 3 questions regarding deductible, payment per month, and type of plan she easily knew the answer to.  As I moved on to ask more questions she was stuck on the co-pay amount, for she was not sure what it was.  She was able to explain to me that she had dental, vision and prescription benefits but was not aware to what extent, and because she has a family plan was also not aware to what extend her family was covered.  She stated she was satisfied with her plan because she had been on this insurance plan for over 15 years. She stated that she looked forward to the yearly briefing and explanation that HR had for the employees because it was here where she would ask any questions she had about coverage.  She was not aware that the organization had employee support programs for counseling etc.  and she also did not know it was free as part of the insurance policy she has.  I have to include myself in this review because as I was asking these questions to her I was also asking myself the same questions and I too failed to understand the difference between key terms like co-insurance and co-pay.  She was not able to explain something to me in simple terms it's as if she was just repeating to me the information she had received from HR.  Overall she was not knowledgeable about her health insurance.  Knowing details about your insurance can help everyone reduce your out of pocket costs in the end without relying too much on your own savings to finance your health care costs.  By becoming more literate in your health insurance one can choose the right and best coverage which can save you money and keep you in the best health.  In reading other peer discussion board post I have found that many of us have discovered that there is a low knowledge about health insurance literacy.  i will go and further look into my own health insurance benefits as I think that I am paying for benefits that I do not use or are not beneficial for me to keep.  

Understanding health insurance plans or programs is relatively tricky for individuals who do not use medical care often. When a medical crisis occurs, or a visit to a physician is needed, most people do not have a thorough understanding of their health insurance. I interviewed a family member regarding their health insurance coverage. Their health insurance plan is a PPO plan, in which they can see outside providers for health care but have to pay more. The person interviewed has been using the same health insurance for over 30 years through their employer. The interviewee indicated that their copay was approximately $30 for primary care. For specialty care, the average copay is roughly $40 per visit. In terms of a deductible, the interviewee did not have one. The interviewee had a decent understanding of what a deductible was. This individual pays approximately $300 per month for their healthcare insurance, which is used by a family size of 4. The healthcare plan includes general healthcare but offers minimal dental and vision care under this plan. Dental coverage includes once a year of teeth cleaning and a dental x-ray. Their insurance plan does not cover any other services for dental care. Vision care includes discounted eye exams only.

For overall satisfaction, this individual is not satisfied with their healthcare plan. This individual does not like the monthly payments, and that coverage for services for dental is not covered. The monthly payment is high. In regards to coverage for services such as mental health care, finding a provider for mental health is very difficult since they are not many providers who accept new patients or accept their insurance. When trying to reach a representative for questions or concerns, the interviewee claims difficulty reaching someone to ask questions. 
I was surprised by the monthly payment for their health insurance. I think $300 is relatively high for medical insurance. Also, it is upsetting to hear problems of services being covered by their insurance considering the large monthly payment. The interviewee did say they like the fact that they can visit outside providers. For example, when this individual went on a skiing trip outside their home state, they had to go to the hospital for injury-related treatment. I was surprised when learning that their cost of treatment was affordable even though this individual was far from home.

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