Ashley Hilfer is a junior at Portland State University, majoring in Nonfiction Creative Writing and minoring in Political Science. She’s currently interning with OSPIRG on campaigns for high value health care. When she’s not working or writing, she loves to hike, read, perfect her baking skills, or work through her Netflix catalogue.
Let’s get straight to the point: the American health care system is not easy to navigate.
It wasn’t something I even thought about until high school, but it was when I started college and got a job that employed me just under full-time that I realized health care, specifically health insurance, was something I needed to worry about. More often than not, getting automated emails and pamphlets from my employer about health insurance only added to my confusion rather than clarifying anything. I didn’t know what “good” coverage was or if the price of a certain plan was reasonable; I had no idea what options there were for me, so I didn’t look beyond what was given to me by my employer, and even that information was something I just barely had a grasp on.
Now, three and a half years later, my growing interest in politics has led me to interning with OSPIRG on their health care campaign. While I’m nowhere near an expert, I’m constantly learning more about how the health care system works. With the knowledge I’ve gained so far, I want to break down the basic building blocks of health insurance and give you a new sense of confidence when navigating the system. So, let’s get started!
Firstly, I want to clarify some key terms that stumped me when I was first learning about health insurance:
Premium: The monthly payment for a plan, which can be on a wide spectrum.
Deductible: The yearly amount you pay for a covered service/medication before your insurance starts to pay.
Coinsurance: The percentage of costs for a covered service/medication after you’ve met your yearly deductible.
Co-Pay: The set amount that you pay each time you go to the doctor or get a prescription.
Out-of-Pocket Maximum: This is a yearly cap for the amount you pay for covered services/medications. Your copay, coinsurance, and deductible payments all count toward this maximum, and once it’s reached your insurer will cover all your medical expenses until your spending resets at the start of the following year.
Subsidies: Tax credits that, if you qualify for, can be applied to lower monthly premium costs when shopping for a private health insurance plan.
Now with these terms defined, let’s tackle the million-dollar-question:
High Value Health Care Advocate, OSPIRG
Maribeth stands up for the public interest in Oregon, working to advance the High Value Health Care campaign. A recent transplant, Maribeth is delighting in all the new hiking trails she gets to explore and photograph.