What does the plan cover?

     Among other things, health care reform in the United States (under the Affordable Care Act) has led to greater standardization of insurance coverage.  Prior to this standardization, the benefits offered varied greatly from plan to plan.  For example, some plans covered prescriptions while others did not.  Plans in the United States must now provide a number of “essential health benefits,” including:

     emergency services
     hospitalization
     laboratory tests
     Maternity and newborn care
     Mental health and addiction treatment
     Outpatient care (doctors and other services you get outside the hospital)
     Pediatric services including dental and vision care
     prescription drugs
     Preventive services (such as certain vaccinations) and chronic disease management
     rehabilitation services

     For our international students considering coverage under a non-US plan, the question “What does the plan cover?” is extremely important.
     How much will it cost?
     Understanding what insurance coverage costs is actually quite complicated.  In our review, we talked about paying a premium to join the plan.  This is an upfront cost that is transparent to you (i.e. you know how much you are paying).

     Unfortunately, with most plans, these aren’t the only costs associated with the care you’ll receive.  Care utilization is generally associated with costs.  These costs are recorded as co-pays, co-insurance and/or co-pays (see definitions below) and are the part you pay out-of-pocket for care.  In general, the more premiums you pay upfront, the less you pay when you receive care.  The less you pay in premiums, the more you pay for care.

     The question for our students is: pay (more) now or pay (more) later?  In both cases, you will be responsible for the cost of the care you receive.  We have taken the approach that it is better to pay more of the original premium to minimize the cost incurred at the time of service.  The reason for our thinking is that we do not want barriers to mentoring, such as a high in-service grant, to discourage students from seeking mentorship.  We want students to have access to health care when they need it