Greetings! I'm Tina. Some say I'm a health insurance whiz, but I don't like to brag. I'm here to answer some frequently asked questions for you.

  • Health insurance is a service that helps cover the cost of providing care to help keep you healthy, when you become sick or injured, or if you have a chronic condition
  • It's an agreement between you and an insurance provider to share the cost of care
  • It protects you from very high expenses when you need health care
  • Without health insurance, it would become very expensive to pay for care if you were to become injured or ill
  • It can give you access to preventive care (routine checkups, screenings, and vaccines) to help you stay well
  • It can reduce the cost of some of your prescription medicines
  • Now, there is a penalty (or fee) for not having health insurance
  • Anyone can get health insurance coverage—there's an option for everyone
  • Even if you have an illness or disability, insurers must give you coverage
  • If you don't think you can afford health insurance, the government has options to help you if you qualify

Find out what health insurance might be right for you

  • Your employer might offer Employer-Sponsored Insurance (ESI)
  • The state or federal government has programs for some groups of people (American Indians and Native Alaskans, people with certain diseases or health conditions, pregnant mothers, etc.)
  • Medicare
  • Medicaid
  • Military
  • On your own
    • Private insurance companies
    • The Health Insurance Marketplace

Learn more about your options

  • There is a period of time called open enrollment. During this time, you can sign up for insurance for the upcoming year
    • For employers, this is often in the fall
    • For the Health Insurance Marketplace, open enrollment for 2017 begins November 1, 2016 and ends on January 31, 2017
    • Some government programs like Medicaid allow you to sign up at any time
  • You can also enroll in health insurance after going through certain changes in your life, called qualifying life events. These are opportunities to adjust your coverage to fit your needs
  • Examples of qualifying life events
    • Birth or adoption of a child
    • Death of a child or placement for adoption
    • Change in marriage status (married, divorced, legal separation, annulment)
    • Change in employment (hired for new full-time job, loss of job, retirement, etc)
    • Loss of coverage from private insurer

Learn more about when to sign up

  • Everyone will need to spend some of their own money on care, but the actual amount you pay for your health insurance depends on things like which plan you choose and how often you need care
  • Tracking your health expenses this year can help with health insurance choices in the future that could wind up saving you money. The Out-of-Pocket Cost Tracker helps you record and add up your out-of-pocket costs so you can make more informed decisions. The Out-of-Pocket Cost Tracker is designed to be used on a computer with Adobe® Acrobat® Reader software, available here for free

Other brands listed are the trademarks of their respective owners and are not trademarks of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.

  • The best way to lower your costs is to stay healthy, but there are other ways to cut down on how much health insurance will cost you
  • Two easy ways are
  • Tracking your health expenses this year can help with health insurance choices in the future that could wind up saving you money. The Out-of-Pocket Cost Tracker helps you record and add up your out-of-pocket costs so you can make more informed decisions. The Out-of-Pocket Cost Tracker is designed to be used on a computer with Adobe® Acrobat® Reader software, available here for free
  • The cost of some services may be different depending on where you get them. Calling ahead to find out the price of certain services at the doctor's office, clinic, hospital, etc., can help you compare costs, so do your homework and shop around. You can also use sites like www.HealthcareBlueBook.com to help you decide.
  • The government might help pay for your health insurance if you get a plan through the Marketplace in 1 of 2 ways, based on your income:

Other brands listed are the trademarks of their respective owners and are not trademarks of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.

  • Once you have paid a certain amount of money for care in a year (your deductible), most plans will help you pay for the cost of prescription medicines with a copay or coinsurance. If you have insurance, check with your provider for your prescription costs
  • If you don’t have health insurance, or have a plan that doesn’t cover prescription medicines, there are ways to lower your out-of-pocket costs
  • Since prescription medicines can have different prices at different pharmacies, comparing costs at your local pharmacies might help you find a lower price. Click here to use a tool that helps you compare costs at different pharmacies in your area
  • Some drug companies help patients with the costs of their medicines. These programs are subject to terms and conditions, and not all patients will be eligible for savings
  • You may want to check if the drug company that makes your medicine offers a cost savings program for which you are eligible. Because these programs can be discontinued or your eligibility can change, you should not rely on them when selecting health insurance coverage
  • Savings offers on certain Merck medicines are available for eligible patients; please see the terms and conditions of the offer for eligibility requirements
  • If you do not have prescription-drug coverage and cannot afford your medicines, you may be eligible for free Merck medicines through the Merck Patient Assistance Program. Get the facts about this and other programs from Merck. Visit www.MerckHelps.com
  • Helen's plan includes a $1,000 deductible. For the first $1,000 worth of health services, Helen pays all of the costs herself before her plan will begin sharing the cost of care with her. Some plans may share the cost of care with you for some services, even before the deductible is met, so check your plan's details to see how your plan is set up
  • Helen's plan includes a $15 copay for her generic prescription medicine. Once she has met her deductible for the year, each time Helen goes to the pharmacy to pick up her medicine, she pays a $15 copay
  • Helen needs minor surgery that will cost $6,000. Since she has already met her deductible and her plan includes coinsurance of 30%, she owes 30% of $6,000, which is $1,800. Her insurance company will pay the remaining 70%, or $4,200.
  • Out-of-pocket (OOP) costs are payments that you pay out of your own pocket
  • They include your deductible and any copay or coinsurance payments you make during the year
  • Even though you pay your premium out of your own pocket, the premium costs are NOT counted toward your out-of-pocket maximum
  • Only services and drugs that are covered by your plan contribute toward the OOP max. Also, remember that many plans will only consider care (office visits, tests, or procedures) from providers that are in the plan's network
  • Use the Out-of-Pocket Cost Tracker to add up your out-of-pocket health care costs and track how much you have spent during the year. The Out-of-Pocket Cost Tracker is designed to be used on a computer with Adobe® Acrobat® Reader software, available here for free

Other brands listed are the trademarks of their respective owners and are not trademarks of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.

To figure out what coverage you might need, first ask yourself questions, such as:

  • Overall, how healthy have I been in the recent past?
  • Do my family members or I have any health conditions?
  • Am I beginning to experience any age-related health conditions?
  • Am I active or do I have an active spouse or children playing sports? The risk of injury might be higher for people with active hobbies like rock climbing, recreational sports, or even running
  • Do I see any specialists (like a podiatrist for foot problems or a neurologist for migraine headaches)?

Your answers will help you decide what features to look for in a plan.

Second, consider what options are available to you.

  • Am I a US citizen, US national, or legal US resident?
  • Am I 65 or older?
  • What state do I live in?
  • Can I get insurance through my job, spouse, parent/legal guardian?
  • How much money do I make per year?
  • Have I served in the US Armed Services?
  • Am I pregnant?
  • Do I have end-stage renal disease, Lou Gehrig's disease, a disability, or am I legally blind?

Your answers will help you decide where you can get coverage.

Finally, consider the cost of your options. Think about each plan in terms of expected monthly and yearly costs based on your health care needs.

One way to balance out costs throughout the year might be to choose a plan with a higher monthly premium. These plans often have lower deductibles, allowing you to begin sharing the cost of care with the insurance company earlier in the year with copays and coinsurance.

If you can afford to pay more on your own each time you need care (and are generally healthy), a plan with a lower premium and higher deductible might be an option for you.

Think about what you can pay for care, and when you might want to pay these costs. When comparing plans, ask yourself:

  • What can I afford to pay as a monthly premium, even if I don't need care?
  • How often do I think I will need to visit the doctor or a specialist?
    • Are these doctors in my plan's network? If not, what will it cost me to see them?
  • How often do I think I will need prescription medicines?
  • How much can I afford to pay on my own before health insurance begins sharing the cost of care? (deductible)
  • What will it cost me out of my own pocket each time I need care? (copay, coinsurance)
  • What is the maximum I will have to pay out of my own pocket for covered services in a year?

Your answers will help you decide how much coverage you need.

Print or download a worksheet to fill in before choosing a plan. Or use the Out-of-Pocket Cost Tracker to help you see how much you paid out-of-pocket for health care with your current health insurance during the past year. The Out-of-Pocket Cost Tracker is designed to be used on a computer with Adobe® Acrobat® Reader software, available here for free

Other brands listed are the trademarks of their respective owners and are not trademarks of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.

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