← She's So Lucky
She's So Lucky
Everything You Need to Know About Health Insurance with Tita Stewart of Elevance Health
00:43:00
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The following podcast is a Dear Media Production hey Bestie, what are you doing on October 21st if you don't have plans yet? I have an amazing idea. I think you should come to Balance Black Girl Live on October 21st in New York City. We're going to be doing a live show at City Winery in New York. It's going to be an amazing girls Night out. So bring your bestie and come join us. If you have enjoyed all of the content I've done this year about your successful era, about leveling up, about stepping into the highest version of yourself, you are going to love love the live show where we really get into all of your questions about how to become the best version of yourself. Tickets are available now. You can get them in the show notes, you can get them at my link in bio on all my social media profiles and make sure you get your ticket soon because you don't want to miss it. Welcome to Balance Black Girl. My name is Les. I am your host and I'm excited to be coming at you with a special bonus episode today. So at the time that this episode is being released, it is currently fall of 2024 and as we move towards the end of the year for many of us there are a lot of adulting tasks that need to be done. And one of those important tasks is selecting our health care for the upcoming year. Especially if you're in the U.S. there is something called open enrollment, which usually happens in November, where we can either select or make changes to our health care coverage for the year ahead. And so we wanted to do a special episode to talk a bit more about health insurance before that time because it can be really confusing for a lot of people. I know for myself, I've experienced a lot of changes this year going from being full time employed by a company that provided my healthcare to now being self employed. And there's a lot of different nuances with that that I'm working through and I got feedback from a lot of you that you are also working through that process and that it can be a little bit confusing. So that's exactly what we're going to talk about today so that you are armed with the knowledge you to get the healthcare coverage you need this fall. So I am joined today by Tita Stewart of Elevance Health who is going to help us navigate this process. Welcome Tita.
- [03:40]
B
Thank you so much for having me.
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A
I am so happy to have you here for you to help us figure out the nuances of this system that can be a little bit confusing.
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B
Absolutely. You know, I think one of the most confusing things to people is healthcare because you just want it there when you need it and not necessarily think about it when you don't need it. And so it's very important, especially for this time of year, for us to share information about healthcare, healthcare benefits, how you can obtain coverage. And at Anthem, we just kind of pride ourselves on really being able to inform, engage as well as really straight talk about healthcare and how you can obtain coverage.
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A
Definitely. Before we get into the nitty gritty and helping people just understand health insurance in general, I would love to talk a little bit more about what health insurance is, what it covers and why it's so important that we have insurance.
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B
Yeah, super loaded question. You just come right at it.
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A
We're starting with the hard stuff early.
- [04:45]
B
Absolutely. So when we think about healthcare coverage, you can think about it in a couple different verticals. And so you think about individuals that are completely uninsured and they're like, what can I do to get insured? And then you have individuals who may know and may have Medicaid or chip, which is what you can have if you're under the age of 18 and your guardian or parents may have a different type of insurance. And then we have our aca, our Exchange product. And so we have a suite of different healthcare options that people can definitely look to say, hey, I don't really know where to start, but I know I need healthcare. And so at Anthem, we have a suite of tools that we try to make it as easy as possible to be able to obtain information on health care. So our, you know, we're going to get to a little bit later, but I would be remiss if I didn't say, you know, www.myhealthbenefitchecker.com is one of the tools that we use for that. But kind of going back to your original question, health care. So healthcare again is there. You don't think about it until you need it oftentimes. But we look at it from a holistic perspective, preventative care. So we want to be there before you need us. We want to make sure that we're providing you the information you need for your immunizations and your vaccine and your checkups for your children. We want to make sure also that in the event of an accident, you're not trying to play catch up with your health insurance company. Most people don't realize like that broken leg or that broken, broken foot can cost you out of pocket about $7,000 if you have no healthcare. And so we think about the various scenarios that could happen without having healthcare. But we really, again, preventative health care is important, but then also making sure that we're there for your accidents of life that may occur and happen.
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A
Yeah, yeah, for sure. And what are some of the common reasons that someone may go uninsured?
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B
Yeah, you know, I think one is confusion, right? Like, I don't know what to do this paperwork, I don't know where to sign up. And so one of the major reasons for that is kind of confusion in terms of where do I go and what do I do? When I think about kind of the state of health care today, 30% of young adults are uninsured. So you kind of think about that number and kind of what it means for society that 30% are uninsured. And so how do we get information in front of them so they can have the knowledge that they need to be able to apply for health insurance. And then also we go a little step further, right? So it's not just the young people that are uninsured, but we also, 64% of the uninsured non elderly population also say the same thing. It's confusion. I don't know where to go, I don't know where to apply, or I'VE applied. I haven't heard back. And so what does that mean? And so that kind of is the state of healthcare today when we think about what do I do if I'm uninsured and how do I get insured. And so that's where Anthem comes in. Right. And so we really, again want to make this process as easy as possible. We. You can always go to anthem.com but again, we have the My Health benefit finder that can really have you answer four simple questions and point you in the right direction in where to receive that healthcare information.
- [07:57]
A
Amazing. Yeah. I took some questions from the audience and I'll get into more of those later in the episode, but one of the common questions I got was, is there a place I can go where I can compare multiple plans or see multiple options? So it sounds like that website is a place where people can do that.
- [08:14]
B
So the My Health Benefit finder will have information that is really germane to the Anthem products and benefits. However, our healthcare.gov which is, you know, what is maintained by our federal government that has the options where you can in fact look across various health plans to say, hey, I kind of like this option or maybe I want this option. We think about what healthcare plans have to offer. For instance, we all have standard benefits that we're required to offer and that we do offer, but we also have additional benefits that go beyond and beyond. And so we really think about the member holistically. So that's from mental health to if you have our Medicaid plans, that could even mean membership at after school program or that could mean some additional benefits that you may not even think about like oil change services or things like that. Again, looking at a holistic perspective for the member.
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A
Wait, I love that you said that. Can we get into that a little bit more? Because I do think that there is some confusion around what specifically medical insurance covers. So can we talk about some of the standard things that most insurers are going to cover, but then also some of those extras and some of those additional things that people may be able to get coverage for?
- [09:29]
B
Yeah, absolutely. So, you know, first disclaimer. No two states are the same. Right. Where was required for the offerings. But for the most part, you know, to your point, there are standard health care benefit options that people have now. Things that people may not know is covered by health care. Mental health. Mental health is covered. As a matter of fact, you know, I'm looking at a quote that we have here that mental health is one of the largest expenses, expenses related to healthcare. And so most people don't know that I can get my therapist paid for. I can go and talk to someone. I can get medication covered related to mental health. And you absolutely can that mental health is healthcare, and we can't say that enough and loud enough. And then we think about holistically, what else is covered from that perspective. Nutritionists are covered. You know, there's a lot of talk around eating healthy, and how do I make sure that what I'm putting in my body is what I need for my body. And so those conversations with a nutritionist are out can also be covered, depending on the state that you live in.
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A
That's really helpful. And I love that you talked about mental health care being covered, because I think that that is a big topic for people. Therapy is becoming a lot more widely accepted. People are feeling a lot more willing to ask for help. But I do think that sometimes finding coverage for mental health care services can be really hard because there's also a lot of therapists who don't take insurance, which I've run into when I'm looking for therapists and things of that nature. Are there places we can go to find therapists who take our insurance?
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B
Yeah, absolutely. So one of the things that we have available to us is telehealth. And so people automatically think telehealth and think physical health, but we actually have mental health providers that operate in the telehealth space. And so this makes it a lot easier or accessible, if you will, for individuals who may not be able to, you know, physically go into a brick and mortar, may not have transportation to a brick and mortar. And it opens up a lot of different channels for other healthcare providers to be able to provide this service for telehealth. And so that is one way where we're, again, trying to break down some barriers and make. Make it more accessible to everyone.
- [11:34]
A
Definitely. And also, when it comes to accessibility and kind of what we were talking about earlier with people going uninsured, I think cost can be another really big factor there where costs of healthcare, costs of insurance can be really high. Are there places people can go to find accessible, affordable healthcare insurance? Why is healthcare insurance often so expensive, Especially if people are doing it out of pocket and it's not sponsored by an employer? What are some options people have there if cost is an issue?
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B
Yeah, let me tell you, before coming into healthcare, in my previous role, I was like the same way, like, you know, healthcare, I just get it through my job and. But if you don't have a job, then what does that mean? Or if you work part time, what does that mean? And so with Anthem, again, suite of products and services that can meet everyone where they are, we have benefits that are catered to our Medicaid population. And so the population that needs a little bit help related to your healthcare, Medicaid is an option in the states. And so we service several states with Medicaid. You don't pay out of pocket that is covered. There's very low costs when it comes to out of pocket costs related to Medicaid and then from there. But we, Medicaid is not a stigma related to the benefits that you get. You get the same benefits and services that are available to anyone that is working from that perspective and have commercial insurance. We also have insurance available to chip, which is the federal program for children. So if you're under the age of 18, whether you live with your parents or you have a guardian, you can get insurance related to that. We also have expansion insurance. So for our states that have expanded Medicaid, there's an expanded option. So there's a lot of non traditional people, people that may have a different course in life where they're in school at a later time period or their income level is a little bit different, there's expansion coverage. And then we also have our exchange products. So Affordable Care act, we have products and services on that, on that plane as well that if you're, you know, you're working and you're not sure if you can afford healthcare insurance, you can go on and look at one of our plans that may be available to you. So again, we like to call it kind of a journey for our members and potential members that we can meet you where you are in every stage of life related to healthcare and all that still kind of sounds a little confusing, but it's really not. If you again go to anthem.com or my health benefit finder, again, we make it really simple, answer about four questions and that leads you down the path. It lets you know if you're more likely to be eligible for Medicaid, if you're more likely to be eligible for one of our exchange products. So it gives you all that information that is available to you. And as an added bonus, it also lets you know if you have additional benefits that you may be eligible for, such as housing or food or SNAP or WIC as well. So that's kind of an added benefit to that website.
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A
Okay, that's really helpful. And for people who are eligible for programs like Medicaid or Chip, are those things that they have to reapply for every year? What does it look like for somebody who needs to maintain that coverage year after year?
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B
Yeah, such a fantastic question and really timely, quite honestly. So through the pandemic, which is the public health emergency was issued. And so when that public health emergency was issued, many people did not have to do anything to maintain their coverage. So they basically maintain coverage From April of 2020 all the way up until this past year. So now that the public health emergency is over, if you are on Medicaid, if you're on Chip, then you would have received communication that said, hey, listen, it's time to take an action. You haven't had to take action in several years. Now it's time to take an action. So Medicaid and CHIP rolls actually swell to about 94 million people. And so now everyone has to go in and renew their benefits. So they have to go in and say, hey, my address has changed, my income has changed. So they have to do this annual renewal, which was always in place, but was suspended for these four years during the public health emergency. And so now Anthem is sending out a lot of awareness, talking directly to our members. We've done events in the communities to have strong community engagement as well as working with our providers because we don't want people to lose healthcare and we want to make sure they maintain their benefits. But again, if you think about how many people are on Medicaid Today, about 24 million people have already lost coverage, and many don't even realize they no longer have coverage until they go to the doctor and the doctor says, you no longer have coverage because you need to go and renew your benefits. So that is a super timely question because we're living in that environment right now where people may be walking around thinking, I have health care, but not have it because they've not done the necessary step to get their benefits to continue.
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A
That's really scary. Is there some way people can check the status of their coverage or see what they need to do to maintain it?
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B
Yeah, absolutely. So most states are online. So we're in. They're online. So members can go into the system of their state and create a login and password and be able to see their status real time if they still have their benefit coverage. If they are thinking, hey, I've been an Anthem member for the past four years, they can simply call the number on their card or within our Sydney app and we will inform them as well.
- [16:59]
A
So I would also love to talk about some of the Common terms and types of insurance that people find really confusing. Because when it comes to health insurance, there's just a lot of words that get thrown out there that even if people have insurance, they're like, I don't know what these words mean. So I would love to do a little health insurance almost kind of like vocabulary session to help people understand the different terms that can help them make the most informed health insurance choices. So the first word that I would love for us to talk about, what it means is premium. What is a premium?
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B
Yeah, absolutely. So premium is the cost that you pay to have insurance in some of our products. Again, Medicaid doesn't have a premium. Some of our chip payments may have a minimum premium that's set. And then if you have commercial or if you have one of our exchange products, you may have a premium that you have to pay. A monthly premium that you may have to pay. It May range from $1 all the way up, but that is the cost that you pay to have insurance. With the exception if you're on Medicaid, then there is no premium for Medicaid.
- [18:05]
A
Got it. So it's either like the dollar amount that you maybe pay out of pocket, or if you have healthcare through your employer and they take out a certain amount of your paycheck each month, it's that number.
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B
Correct.
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A
Okay, now what is a deductible?
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B
So a deductible is, is again what you have to pay. So this is again an out of pocket cost. A deductible is what you have to pay as part of the service. So you may have a percentage that you have to pay. If a service costs $10, they may say you have a $2 deductible. Or it can range based on the type of service that you're receiving, the type of procedure that you may have to have, or it may range based on your insurance type.
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A
Got it. And so I think what's probably confusing for people is like, wait, so I'm paying for the premium, I'm paying for the deductible. Why are these two things different? What am I paying for?
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B
Yeah, so the premium is almost like a main, a maintenance cost that you pay to for having insurance. And then deductible is only paid when there is a usage of the service. And not every service calls for a deductible. So again, it varies in the state that you live in and the type of product that you sign up for. But not every service requires a deductible. Again, if you're on Medicaid or if you're on chip, there is no deductible for those two products.
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A
Got it. And for most kind of standard insurance plans, what happens when someone meets the deductible?
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B
So typically when someone meets a deductible for that year, because deductible start over every year, then you don't have to have, you don't have any additional costs for that deductible once your deductible has been met.
- [19:41]
A
Got it? Yeah. And for these two terms that we just talked about, premium and deductible, you know, some of those may vary depending on what type of plan you have. So you may have a high premium plan that has a lower deductible or a high deductible plan that has a lower monthly premium. Can we talk a little bit more about the differences between these two types of plans and maybe who could be better served by each type?
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B
So when you get into the high deductible and the low deductible, so there's lots of things to take into consideration that could be the type of provider, if there is an ongoing ailment that you are, you know, that you have that is maybe a maintenance. So it really depends on the type of healthcare service that you plan to have. Some people are like, I'm probably never going to go to the doctor. I only need to go to the doctor for my checkup. And that is the type of plan that I'm looking for. So I'll take a lower deductible because I'm not going to the doctor that often, or a higher deductible. Some people are like, well, I'm going to the doctor all the time. And so their plan may look and feel very different from someone and the amount of time they spend in provider.
- [20:50]
A
Offices, that makes sense. So looking at it as almost kind of like estimating what care you think you would need for somebody who maybe has some sort of condition or who, you know, maybe has something going on where they see a doctor more frequently, it makes sense to maybe pay a bit more in that monthly premium so that you have a lower overall deductible versus for people who may not have that. And they usually maybe go just for their annual or maybe one off things, it probably makes a little bit more sense to pay a little bit less each month and have that higher deductible.
- [21:22]
B
Correct. And we always like to say healthcare is customizable. Right. So when you think about the type of plan that you would need, when you think about the type of services that you need, it's really customizable to you and your family needs.
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A
And also when it comes to the varying, you know, high deductible, low deductible plans, something that often comes with high deductible plans is the ability to participate in an hsa. And I think that that is also confusing to people. Can we talk about what HSA stands for and what an HSA is?
- [21:53]
B
Yeah, so that's a little bit different because that goes into your kind of commercial insurance and that goes into the, the, the insurance that are offered by your workplace, which is bit different when you're thinking about those who are getting insurance through Medicaid or through chip or through aca. So it's a little bit different from that scope. And so we can go into it, but it's a little bit different than what your kind of non traditional. When you think about a Medicaid or a chip, they don't have access to the hsa. And from that perspective, it's more so on our commercial side.
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A
That makes sense. Yeah, I would love to still maybe touch on it just so that if anyone is confused about what it means, they understand.
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B
Yeah, absolutely. So that is where you pay, I mean it's almost where you pay into a sub account or you have a sub account where you can use those services for over the counter. You can use it for services that are related to health care but may not be covered by your healthcare plan.
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A
Got it. So it's almost like a savings account or kind of like a bank account or piggy bank that is specifically for health related expenses.
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B
Exactly.
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A
Okay. Got it. And I think where people also get confused with the HSA is that there's also an fsa. So what does FSA stand for and how is that different from the hsa?
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B
Yeah, so people hear a lot about fsa. And so when you think about it from a flexible spending account, when you think about that. So when I think about flexible spending account, I think about, oh, I can go get specialized toothpaste or I can get, get some vitamins. And so it's almost like an over the counter account, if you will, related to that, where you can pick items. It's kind of like a savings account as well, but you can pick items that are, you may walk into your local CVS or Walgreens and be able to get those items.
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A
Got it. And is there a specific time period for each of these accounts? Do the funds expand, expire for an HSA or fsa?
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B
Yeah, so the FSA rules are you know, there is a limit from a contribution perspective, without having it directly in front of me, I think it's about 2850 a year. As to what, 2850 or 3000 as to what you can put into that account. And they do expire every year, so they start over annually.
- [24:18]
A
Got it. So if someone has an FSA that they're contributing to that year, you need to make sure you use those funds before December 31st because they don't roll over.
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B
That's correct. Very similar to the Health Savings Account. So which is the hsa? Very similar to that as well.
- [24:32]
A
Couple more terms because this is super helpful I think for people who like don't understand, especially for young adults who are navigating this for the first time.
- [24:40]
B
Absolutely.
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A
Can we also talk about the difference between HMO and ppo, what those things stand for and what is the difference between those two things?
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B
Yeah, that is a question that definitely gets a lot of kind of what is the difference between the two. So I just also want to just premise. So Medicaid and chip, they don't have to worry about the difference between HMO and a ppo. They have access to all the providers that are within those networks for Medicaid and chip. For a ppo, which is preferred provider organization. I even have to think about it myself when I'm thinking about the terminologies related to that really is the network. Right. So it's really based upon comparing the network related to the type of providers that are direct access versus providers that are in a more extended access version and that can include like one has like more special medical needs within HMO versus just kind of the preferred network of general providers which are in a ppo. But those are all terms that fall under again your commercial insurance.
- [25:51]
A
Okay, got it. And which one has a broader amount of providers available to you? Is it the HMO is like a little bit more limited in the providers you can see and the PPO is more broad or is it vice versa?
- [26:04]
B
So the PPO basically are favorite because they have greater flexibility in choosing the healthcare providers and the lower need of referrals to see a specialist. So that is kind of the difference with the PPO and the ppo. They allow for some coverage for some of the out of network benefits, whereas the hmo I don't want to use, don't want to use the term restrictive, but it is a little bit more restrictive from that perspective.
- [26:31]
A
Got it. So it's like a little more specific with who you can see in an hmo.
- [26:35]
B
Correct.
- [26:36]
A
Okay, got it. That's super helpful. And then another term that I would love to talk about because you know, we mentioned earlier that open enrollment is coming up, that at the end of the year it's very common. Common to need to make a lot of choices related to healthcare, but that may not necessarily be the only time you can make changes to your healthcare. So can we talk about what a qualifying life event is?
- [26:56]
B
Yeah, absolutely. So there are a couple qualifying events that you can have. So obviously having a baby will be one. The other one could be a change in income status. Right. So you have a job, you no longer have a, have the same income that are coming in from that job. You get married or enter into a, you know, kind of a different relationship related to that could be a qualifying event as well. Adopted, you can adopt children will be the same as having a child. So bringing a new child in as well. So those are some of the examples of a qualifying event.
- [27:30]
A
Okay, got it. So that during those times of life is when people can make changes to their health insurance outside of the open enrollment period.
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B
Correct. And also I said getting married, but I didn't mention getting a divorce because that could be grounds for considered a qualifying event as well as moving in and out of state.
- [27:48]
A
Okay, got it. And is turning 26 also a qualifying life event?
- [27:52]
B
So turning 26, as you know with the ACA Affordable Care act, you can have coverage up until you're 26, so your parents can cover you up into that 26 mark. So yes. So turning 26 is time for you to get your own insurance. You can no longer be covered under your parents insurance.
- [28:08]
A
Okay, got it. And you know, when these qualifying life events happen, is that also when people should go to like a healthcare website to figure it out, Will they get some sort of notification saying, hey, you're about to turn 26, like what does it look like? How do people know when it's time to act on that?
- [28:25]
B
Yeah, absolutely. So oftentimes when you're turning 26, your healthcare provider. So with Anthem, you receive notification or the parent receives notification. Right, because the parent is actually the owner of the policy, if you will. So they receive notification like, hey, you got somebody turning 26. They may, you know, did you know we have these other offerings for them. And so we do the same thing at 18 in Medicaid. So in Medicaid and chip, when you're getting ready to turn 18, it's the same situation that is considered a qualifying event for that age group under that product. So it's Kind of like that birthday text that says, hey, oh, by the way, it's time for you to inform your child or whomever you're guarding that it's time for them to look for healthcare insurance. They will not be covered after this year. So that is information that is shared with everyone. And then we say, hey, we offer these suite of services that they may be interested in or at the same time we make available from our community outreach and our community ground game. We're really heavily into our communities, educating people every day in person, not just sending information that through the mail or through texts or phone calls. We literally do a lot of ground game events in the communities that we serve, becoming a piece of the fabric in the community. So we're doing more than just providing healthcare. But again, that holistic member, because it's one thing for me to tell you what you need to do over the phone and through text and you're worried about, I need to get diapers for my child or I need to make sure I even have food to feed my family. So, yes, it's important for me to do these things, but I have to do these things first. And so we're in the community quite a lot in terms of looking at areas where we can do diaper days, where we can put on community baby showers for our members that's packed not just with gifts, but with resources and information. So again, looking at the holistic approach for our members. And so part of that is, hey, you're turning 18. Hey, this is, you know, this is an expansion where you can get our coverage on our exchange program, or, hey, did you know you can, you may qualify for this benefit of these services.
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A
That's good to know. So it's not like, hey, you're about to get kicked off, but like, hey, this is a transition. Here are some other offerings that you can opt into.
- [30:34]
B
Correct. Because unfortunately, we can't just place you in those. There has to be. There is an application. You know, there is a. I have to go in and put in my information from that perspective, because if we could just totally place you in there, we would. But that's not how that works.
- [30:48]
A
Yeah, that makes sense. That makes sense. So it looks like. Sounds like there is a bit of kind of proactiveness that the person has to take to be able to actually opt into the changes when those life events occur.
- [30:59]
B
Correct, Correct.
- [31:00]
A
Okay, good to know, Good to know. So another question that I have is that there's a lot of confusion around how some of the things that I think we would all think of as healthcare are a little bit separate. So, like, your health insurance is separate from your dental insurance, and for some people, it's separate from your prescription coverage. And I think that can also be really confusing for people because just because you have health insurance doesn't mean that when you go to the dentist, that's going to be covered, or when you go to the eye doctor, that that's going to be covered. So are there also resources that can help people get that holistic coverage overall? Is it possible to group those things together? Why are they all separate?
- [31:42]
B
You know, it's interesting, we like to say when you see one state, you see in one state because they operate a little bit different. There's no kind of global piece to that. And so in some areas, there is one card for all your services where you get dental, you get vision, and you get your physical healthcare needs along with your mental health needs. But in some areas, unfortunately, there is, you have to have a dental, a separate dental plan, a separate vision plan, and then you also have the physical services. So I think when it comes to Medicaid and chip, all of that is in one, depending on the state. And when it comes to our commercial plans or ACA plan, it really depends on that, that state and how that's set up. But we, I think the preference obviously is to carry one card to be able to do that. But I think we're bound by some of the restrictions that are within how that program is designed. So to answer your question, which is not really an answer, is that yes, sometimes you do have to have a separate dental plan and a separate vision plan that is separate from your physical health.
- [32:45]
A
Yeah, yeah. So I think it's just good for people to know kind of what the regulations are in their state and to understand what all they need to opt into.
- [32:56]
B
Right. And what the benefit offerings are, quite honestly. And then sometimes you're able to have the same insurance company for all three, and sometimes you're not, depending on your. Your state that you reside in.
- [33:08]
A
So I would also love to get into some audience questions. Before I sat down for this interview, I posted on Instagram asking my audience, what questions do you all have about health insurance? And we got some really great questions, so I'd love to dive into some of those. No, I think you'll be just fine. You'll be just fine. And for a lot of them, we got kind of duplicate questions asking very similar things. So I did paraphrase a little bit for kind of commonly asked questions that we Got so a big one that a lot of people had that I also selfishly have is how can you find good affordable health insurance when you're self employed or a freelancer?
- [33:49]
B
Yeah. And I think early in the call I kind of talked about that, but really we built the tool, which is an innovative tool for that we launched, which is the my health benefit finder.com and so if you go to that tool again, there's four simple questions that you answer that you know, income related as well as address and zip code. So they can pull that information down for you. And it will point you in the, it will point you in the direction of where the, where you apply for Medicaid or you apply for one of our ACA products. And so that actually is a really great tool that we have that people can use. And so that's a great way to look from a shopper experience. Of course, the federal government does have a healthcare.gov for individuals as well that lets you compare plans.
- [34:34]
A
Okay. The next one says if you're with an employer for multiple years, do you have to reset coverage every year? So we talked about this almost kind of from a Medicaid perspective, but for people who maybe have more of a commercial insurance situation, should they be going in and re enrolling every year? Yeah.
- [34:52]
B
So if you have commercial insurance, which you know, Anthem is one of the largest Blue Cross Blue Shields across the country, you do have to follow your employer's rules, which is usually an annual open enrollment as well. So everyone gets an open enrollment period. And so even, you know, Medicaid commercial, everyone gets an open enrollment period. So even if you do have employer covered insurance, there is an opportunity for you to go in from an open enrollment perspective and like you say reset. Right. Like you may say, I may not need as much flexible spending this year. I may want to change to a different deductible plan. I may want to change from an HMO to a ppo. So you have that opportunity once a year to do that for your commercial plans. And with Medicaid you have the opportunity to go in and say, you know, I've had this company and maybe I want to try a different company so those opportunities are available for you.
- [35:42]
A
Got it. That makes sense. And I think it's also good, even if you want to keep the same coverage, just to go in, check it out, see what's going on, even if it's through your employer. Like, has your employer changed the premiums? How much will you be paying? Like, it's just good to opt in and absolutely see what's going on.
- [35:58]
B
Absolutely. Because there without a doubt there's probably some type of changes that are occurring even with, you know, a commercial coverage that may be a little different. Our exchange and with same with our Medicaid.
- [36:08]
A
In our chip, someone else said, how can you take full advantage of your health insurance offerings as a healthy adult?
- [36:16]
B
Yeah, that's actually a great question. I'll answer in a couple of different ways. One thing is again, most people don't realize like my mental health is covered. So they may feel like they have to go out and pay out of pocket for a lot of expenses that may in fact be covered. And so no one likes to shift through a 200 page member handbook, quite honestly. But we do have our Sydney app that you can go in and you can chat and ask questions within our app to ask those type of questions so you can get your answers to that. And then, you know, healthy adult, you still need preventative care. Right. So you can, you can be the most healthiest person, but you still need to get your wheelchair checkups, you still need to get the vaccinations, those things that are needed. And so we actually have all that information on our website from a preventive care perspective. But then again, our Sydney app, you can chat back and forth with us around, hey, what are some benefits and services that are offered to me from a maintenance perspective or preventive care area? And so all that is available, we think about nutritionists and eating healthy. And so that information is available at no additional cost as well.
- [37:21]
A
That's great. Yeah, it's so helpful for people to just look and see what all is covered. I know in the past I've had healthcare coverage that offers to pay a portion of my gym membership every year or to reimburse me for certain fitness expenses and stuff like that. So to take full advantage of anything like that is 100, 100%.
- [37:45]
B
When I think about our value added benefits for our Medicaid and our CHIP members, I think about the mom that may be recently released from the hospital that we send tailored meals to. So people may not realize that that's a benefit that is available to them or the free boys and Girls Club membership that they can have their children participate or the free Girl Scout membership. So they're again looking at the member from a holistic perspective and not just in just kind of a singular view based on the physical need.
- [38:12]
A
That's great. So it sounds like there's, there's a lot more to coverage that meets the eye and that if we dig into the details, we might find some gems that we can get support with.
- [38:21]
B
Absolutely.
- [38:22]
A
So if someone is, let's say, entering their first corporate job and maybe this, you know, open enrollment period, it's going to be their very first time having to select health insurance for themselves and they just feel super overwhelmed, what do you recommend they do to make that process less overwhelming?
- [38:43]
B
Yeah, so I think it depends on a couple different things. So, gosh, I'm trying to think back to the last time I entered my first corporate job, and it was almost 20 years ago. But when you, when you think about it from a healthcare perspective, one see what the offerings are from your company. Right. So you, you will be offered healthcare information when you begin your employment journey. And so understanding and really to sit down and ask the question of that, your open enrollment, professional, hmo, ppo, high deductible, low deductible. But at the same time, there may be offerings that are, that are available to you from a CHIP perspective. Say you have, you're a young parent and you have children. Do I have to have my kids covered with my commercial insurance? Or can I use a CHIP benefit, which most folks say, you know, maybe I can't afford for everybody in my family, but my children can be covered here instead. So really understanding and knowing the CHIP benefit that is available and at the same time, is the employer benefit, the benefit that is right for me, Is there an ACA plan depending on, you know, kind of your income coming into the workforce? Is there an exchange product that can be used? And so Anthem.com, we list out our Medicaid plans, our CHIP plans, our individual plans. We have all the information listed there for people to review and read and gather a deeper understanding.
- [40:03]
A
Good to know. So it sounds like in that scenario, the best thing to do is maybe block out some time on your calendar, just for research, look at all of the options available to you and take that time to just lock in on the most informed decision that works best for you in this moment.
- [40:19]
B
Absolutely. I think an informed decision is the best decision. And so again, taking that opportunity because your healthcare is, you know, that's one of the most important things that you can do from a preventative and from, you know, when there, if there is an accident that occurs.
- [40:35]
A
Yeah, definitely. I think that that's also something that I don't think enough young people think of as they're like, oh, well, I'm young, I'm healthy, you know, I don't need it. And it's like, sure, great, but what if you get in a car accident? What if you fall off your bike? What if, you know, all of these things that are maybe no fault at all, that still could end up costing you thousands of dollars if you don't have the coverage that you need?
- [40:57]
B
You said it the best, right? I mean, no one thinks about breaking a leg walking down the street, right? Or, you know, and so that those things happen. And so for us, we're like, like, let's be prepared in the event that those things happen. Because trying to play catch up on the back end when you think about things like healthcare debt and how you can avoid it is really, let's look and see. Am I eligible for Medicaid Chip individual coverage? Is there any type of health care that I can receive? And so again, it starts with, for us, using that tool, My Health Benefit Finder can really take you down the right path there.
- [41:32]
A
Awesome. So before we head out, I would just love to kind of see if there's any additional resources people can work through. Let's say they go through the website, they see some options there, maybe they're a little bit confused and they're like, I just need someone to sit down with me one on one to explain this to me. Is it possible for people to talk to an expert to get their input on what plans might work best for them and if so, how can they go about that?
- [41:58]
B
So I've mentioned it a couple times that our Anthem.com website has a ton of resources that are available to everyone. Our My Health Benefit Finder has that information. If someone is already an Anthem member, they can actually log on to our Sydney app and they can live chat with someone in our Sydney app as well. And you know, we, again, we also make sure that if you want information related to your individual commercial needs, there is a person on your membership card that you can talk to as well. So we try to make a lot of different resources available. They can also find us in their community, in the communities that we serve. We do a ton of events around the states in specific zip codes and areas where we can answer questions in person at the same time. So we're super open and super excited to be able to offer services, healthcare services that again, take care of the whole person, not just the physical health.
- [42:49]
A
Awesome. Thank you so much, Tita. And we will make sure that we have those resources linked in the show notes so that everyone can check it out, they can explore, they can start comparing because before we know it, open enrollment is going to be here and it's going to be time to make some decisions.
- [43:04]
B
Absolutely. Thank you so much for your time today, Liz. I really appreciate it.
- [43:07]
A
Thank you so much for joining me. And thank you so much for tuning into this episode. Like I said, all of the resources that we mentioned in today's episode will be linked in the show notes. So if you have questions about health care, health insurance, we will link all of the websites and information below. If you enjoyed this episode, please make sure that you're subscribed on Apple, on Spotify, on YouTube. Leave us a rating and a review. If you enjoyed the show, we would appreciate your five star reviews. Thank you again for tuning in and I will see you next week. Please note that this episode may contain paid endorsements and advertisements for products and services. Individuals on the show may have a direct or indirect financial interest in products or services referred to in this episode.