Jimmy Kimmel’s Healthcare Scare: What You Should Know

As you may know, on May 1, 2017, Jimmy Kimmel spoke about the birth of his baby boy, Billy.

If you haven’t seen the clip, click here to watch.

Unfortunately, several hours after the birth of his baby, Jimmy and his wife Molly learned that Billy had a heart defect and needed surgery to save his life.

Jimmy thanked Cedars-Sinai Hospital and Children’s Hospital Los Angeles for providing Billy with amazing care. Because of the attentive staff and great care, his newborn son is home and doing well.

Jimmy’s message was extremely important and shows how far we have come in healthcare, and how far we have to go.

Friends, family, and readers have asked me some questions about what Jimmy had to say. Here’s my take:

Jimmy spoke about “pre-existing conditions.”

Question: What are pre-existing conditions and how do they affect healthcare coverage?

Answer: Pre-existing conditions are health problems that occur prior to the date new health coverage starts.

Jimmy is correct that prior to the passage of the Affordable Care Act (“ACA”), pre-existing conditions, such as birth defects, could prevent someone like baby Billy from getting coverage. They also enabled insurance companies to charge individuals more. The ACA now prevents health insurance companies from refusing coverage or charging more for pre-existing conditions.

Question: What is the National Institutes of Health (“NIH”)?

Answer: NIH is part of the U.S. Department of Health and Human Services and is the nation’s medical research agency. Jimmy is correct that, despite initial plans to cut the budget for NIH, Congress increased its funding by $2 billion.

As a mother of two and a parent of a daughter born with a serious disease, I was touched by Jimmy’s message. It’s important to stay in the know about healthcare and healthcare policies, in case you or a loved one is impacted.

Congratulations to Jimmy Kimmel and his family on their baby boy!

To learn more about health care for your family, check out the Women’s Mind Body Wellness Summit. It contains 6 interviews by top female health professionals plus two workout videos and 3 bonus videos on mind-body wellness with MyHealthSpin founder Lori-Ann Rickard.

Sneak Peek: What doesn’t your health insurance cover?

Exciting news!Medically Underinsured

I was recently contacted by the fabulous website Grandparents.com with some questions regarding health insurance and what it doesn’t cover. I have been approached many times with questions about health insurance, as it can be very confusing to navigate.

Did you know that the average age of a grandparent in the United States is 48? Neither did I. Grandparents, along with many other people, struggle with finding healthcare coverage for themselves and their loved ones.

We shared a lot of interesting information with Grandparents.com. Here is a glimpse at only a few of the many interesting facts we discussed:

  • Insurance is essential. Make sure to research and compare insurance policies before selecting a plan. Consider if the plan covers your prescriptions, physicians, and services you need or may utilize in the future. Make sure to use your medical life list when evaluating options.
  • If your insurance tells you that alternative therapies, such as massage or acupuncture, are covered services, make sure to find out what is required for them to be covered, how many visits are covered, and what health care providers you can see. Unforeseen costs can be burdensome, so make sure you know before you go!
  • A good rule of thumb to determine whether a service is covered by insurance is to ask yourself whether or not the service is a medical necessity? This can be tricky, but usually insurance companies say services such as travel vaccinations or massages are not a medical necessity, and therefore are not covered.
  • If you are receiving high out-of-pocket costs for services that are not covered, look for a plan that better suits your needs. If that’s not feasible, talk to your doctors and ask if they will put you on a payment plan or offer discounts for paying in cash.

For more information, check out the article today on Grandparents.com and make sure to let us know what you think!

For more healthcare tips for you and your family, check out my workbook for dealing with caring for your children, as well as your aging parents: Life in the Sandwich Generation. Life in the Sandwich Generation is a workbook filled with information, tips and tricks for managing the demands needing to care for your aging parents, as well as taking care of your children. It details how you can involve your children in the process and how to learn more about your parents health and finances, while still making time for yourself and your spouse. You can find it here for only $10!

What is a deductible, coinsurance, and copayment?

Insurance PolicyIt can be difficult to understand your insurance. Deductibles? Copays? Out-of-pocket maximums? What does this all mean? Knowing what these terms mean can make the task of choosing the insurance policy a lot easier. It can also help you to ensure that the policy you are choosing is within your budget and you don’t get stuck with any unexpected costs.

Today, we will discuss what a deductible is, what a copayment is and what coinsurance is. Knowing these terms when choosing a plan, as well as when visiting your doctor, will save you a lot of time and money.

First, what is a deductible? A deductible is the amount of money that you must pay for services before your health insurance kicks in. For instance, if you have a $5,500 deductible you will have to pay that whole amount out of pocket before your insurance pays a dime. Due to this, it is often advantageous to find a policy that has a lower deductible. Most people will never meet that high of a deductible, unless there is a medical emergency.

This can make it tricky when choosing insurances, especially through the market place. Most policies with low premiums have high deductibles and vice versa. This can make these policies more desirable because you may only be looking at what you will pay each month as opposed to what you will pay when you actually use your insurance, so make sure you choose a plan that fits within your budget and needs. One important thing to know is that plans through the health insurance marketplace pay in full on preventative services, regardless of if your deductible has been met. It is also important to check if your deductible if plan wide or if it has separate deductibles for things such as prescriptions.

You may see “individual versus family deductible” as a part of your policy’s description. The family deductible is typically higher than the individual deductible. However, this can be beneficial in some cases. For instance, let’s say your spouse has a procedure that costs enough to meet the family deductible. This means that everyone else on your policy has met their deductible too, even without stepping foot in a doctor’s office. If you have several members of your family on one plan, it may be a good idea to look into a policy that offers those benefits.

Second, what is co-insurance? Co-insurance is the percentage of the cost of a covered health service that you pay once you have met your deductible. For example, if you have a 10% coinsurance you will be responsible for 10% of the services rendered and your insurance will pick up the remaining 90%. So you may be thinking, wow, this sounds awesome! And it is, especially if you have a plan with a low deductible and a good co-insurance percentage. But then what if you have a procedure with an astronomically high allowed cost, like a heart attack, for example?

This is where your out-of-pocket maximum comes in. The out-of-pocket max is the the maximum amount you will have to pay toward your insurance for the year. Once you meet that number your insurance covers the rest of your services. This is a good way to protect yourself in cases of catastrophic health events. Therefore, it is important to know what your out-of-pocket maximum is, especially if you are of the population who is at higher risk for these major health events.

Third, what is a copayment? A copayment is a set dollar amount you pay for a covered product or service after your deductible is met. For instance, if your plan has a $40 copayment on a visit with your primary care physician, it will cost you $40 to see your doctor, assuming your deductible has been met. Also, with some plans, the deductible does not apply to certain services. For example, many chiropractic plans just have a set copayment regardless of if your deductible is met. Furthermore, the amount of your copayment can vary per service on your plan like for prescriptions or specialist visits. Like with the deductibles, it is typical that plans with lower monthly premiums will have higher copays.

If you’re still having trouble navigating your health insurance pick up my books Easy Healthcare: Choose Your Health Insurance and Easy Healthcare: Obamacare. These books include everything you need to know about how to choose the plan that best fits your healthcare needs.

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