Using Insurance

Insurance can be confusing and difficult to engage with! Below we share some information and tips. But remember, if you have questions about your specific health insurance plan, you can always call the number on the back of your card and ask them any questions!

How do I get health insurance?

Most people have private health insurance, public health insurance, or health insurance through their school.

Private Insurance. People can get private insurance through their job or through the job of their parents/guardians’ job or spouse. People can also buy private health insurance through their state’s insurance marketplace. If your parents have private health insurance, you are most likely covered on their plan and can stay on their insurance plan up to age 26

Public Insurance such as Medicaid or Medi-Cal. People qualify for public insurance based on income and/or disability status. If your parents have public health insurance, you are most likely covered on their plan.

If you don’t have insurance, you can sign up for Medi-Cal: if you are under 21, Medi-Cal only counts your own income, not your parents’.

In some states, Medicaid recipients are assigned to a provider. If you don’t like that provider for any reason, it is within your rights to ask for a different provider. Usually this means calling the Medicaid office, which can take a while, as wait times can be long! Call when you have enough time to wait, and make sure you have something else to do while on hold.

School Insurance (if in college). Many colleges and universities offer student health plans to full-time students enrolled in their school. You often have to pay some costs for these plans.

How do I use my insurance?

The most practical thing to know is to make sure to carry your insurance card with you. It shows what policy you have and has information that the clinic needs. You will be asked to show this card when you are checking in for a healthcare appointment. The card will also have a phone number you can call or a website you can visit to find providers that are “in-network” or that accept your insurance policy.

Insurance will often cover medications too. You will also want to make sure to carry your card with you to a pharmacy. Not all medications are covered by all health insurance plans. If you find out at the pharmacy that your medication isn’t covered, ask the pharmacy to contact the prescribing provider to ask for a different prescription that will be covered. If it is covered by your insurance, you may still have to pay a copay, usually $5-$15. If the medication is not covered by your insurance at all, they can often prescribe another brand that is covered.

Get to know your insurance.

Your insurance card contains a lot of information. Click through this example card to learn how to find out important information about your insurance. You can also pull out your own insurance card and compare!

(INTERACTIVE STUFF BELOW) HMO (Health Maintenance Organization). In an HMO, you are assigned or told to choose a “primary care provider” (PCP) who manages all of your care. Under this type of plan, you need to get written approval from your PCP to see any type of specialist. (TIP: Don’t know who your PCP is? Call the number on your insurance card!)

PPO (Preferred Provider Organization)/ EPO (Exclusive Provider Organization). Under a PPO or EPO, you can see any provider you want – no need to see a PCP first. However, you will pay less if you see an “in network” provider. Your insurance plan will provide you a list of providers that are in-network. You can usually find providers on the insurance company’s website or by calling the number on your insurance card.

Premium is the amount of money you pay each month to have health insurance.

Copay is a set amount you pay for services covered by your plan. You may have copays for doctor office visits, emergency or urgent care visits, prescription medications.

Some plans have requirements that you spend a certain amount of money on health care before they will pay anything. This is called a deductible. For example, if you have a $100 yearly deductible, you will have to pay $100 worth of the costs of any doctor’s appointments, medications, etc. in a calendar year before your health insurance pays for anything.