Health Break: 5 things you need to know about health insurance in 5 minutes

Camille: Welcome to Health Break by UPMC Health Plan, your quick guide to health, wellness, and how to make the most of your health insurance plan. Listen during your coffee break, lunch break, or anytime you need a break. I’m your host, Dr. Camille Clarke-Smith. I help to oversee the quality of the plans we offer at UPMC Health Plan.

Alex: And I’m your co-host, Alex Treanor. I’m a senior health coach who works with our members on healthy lifestyle habits and goals. This is your… Health Break.

Alex: Hey everyone! I’m Alex Treanor. In the next five minutes, Mike Ahern and Joyce Reagle are sharing the five most important things you need to know about health insurance—from eligibility and coverage to hidden benefits and other extras.
Mike and Joyce, thank you so much for being with us today.

Mike: Great to be here.

Joyce: It’s good to be here.

Alex: What are the top five things we need to know about health insurance?

Mike: Yeah the first thing I would like to talk about is actually enrolling into health insurance. Depending on the type of coverage you’re looking for, there’s a specific time during the year that you can enroll in a plan or update your health insurance. This period is called open enrollment. Open enrollment usually takes place every year between November 1st and January 15th for individual plans, while for Medicare, the Annual Election Period takes place from October 15th to December 7th and their open enrollment period takes place from January 1st to March 31st.
Group plans, and those are plans that are sponsored by an employer, are subject to their own open enrollment periods. If open enrollment has ended, you might still be eligible to enroll in a plan if you’ve got what’s called a qualifying life event. These are things like getting married or becoming a parent, having a change in your job or income, or aging out of your parents’ plan when you turn 26.

Joyce: Another important thing to know about your insurance is to know your network. And why is that important? Because your insurance may not be able to help with the cost if you go outside of your network. So you want to try to get care within your network. If you do have a visit with a provider or hospital outside of the network, you may not be able to get help from the insurance with the cost, or you might get help, but still have to pay more out of your own pocket.

Mike: Costs are important. It does cost more to go to the emergency room than to your primary care provider, referred to as a PCP. Many PCPs have after hours options or virtual appointments, so you can get help without the higher cost and longer wait that you might experience in the ER. Our members also have access to virtual urgent care anytime, anywhere through UPMC AnywhereCare. It’s important to remember that in an emergency, our members can visit any hospital, even if it does not participate with the UPMC Health Plan. Your emergency care will be covered at your highest benefit level, and this is true regardless of the network that you select.

Joyce: That sounds great, Mike. Another thing about having health insurance is, you may have access to a lot of services at no additional cost. These are things like annual physicals, well-child visits, most vaccines, and preventative screenings. There’s even wellness programs to help you quit smoking, lose weight, manage a condition, or achieve your health goals [and these programs] might be included in your plan.

Mike: And the most important thing to know is that there are people available to help you every step of the way. For Medicare or individual and family plans, at UPMC Health Plan we have a team of specialists who can help you enroll online, over the phone, or in person at one of our UPMC Health Plan Connect Centers. When you become a member, our award-winning Health Care Concierge team provides outstanding service, whether you have a question about claims, need to find a doctor, or just need to have something explained. Our members have access to other resources like health coaches, in-network doctors and providers, and the UPMC MyHealth 24/7 Nurse Line.

Alex: Thank you so much, Joyce and Mike, for taking a Health Break with us today.

Mike: Thank you; I enjoyed helping out.

Joyce: Pleasure being here.

Alex: If you’re buying health insurance for the first time, or just looking to understand your plan better, visit our website for more information about health insurance basics.

Find show notes and more information at upmchealthplan.com/podcast. Join us as we explore other health and wellness topics in the next episode of Health Break.
This podcast is for informational and educational purposes. It is not medical care or advice. Individuals in need of medical care should consult their personal care provider. Views and opinions expressed by the hosts and guests are solely their own and do not necessarily reflect those of UPMC Health Plan and its employees.