“Truisms” of Young Adult Healthcare

As I worked with my stepson on obtaining insurance quotes, I thought it would be a bit easier.  As a healthcare professional with many years of experience, I intuitively knew what he needed but I found myself grasping for words and analogies to interpret the concept of “out of pocket”, “co-insurance” and other necessary insurance terms to understand pricing and select the right product. I found all the sites we reviewed for quotes had excellent descriptions but could still be overwhelming without an initial conversation or dare I say, learning session, hopefully with a parent or guardian. I did my best, still stumbled, but we got through it and purchased a good product that met his needs at the time.

The “Truisms” of Young Adult Individual Healthcare Insurance (as of 2012)

Some geographical areas offer short-term medical coverage (less than six months) and ongoing medical coverage (greater than six months.)

Similar to auto insurance, you will pay a monthly premium. The premium amount may be based on your gender, age, height, weight, smoker status and at this point, pre-existing serious conditions.

Healthy, young adults generally pay less than older adults.

Costs may vary based on how much you want to pay out of pocket beyond the monthly premium throughout the year.

Costs may vary based on if you want:

1)      Basic coverage to cover you for inpatient hospitalizations and outpatient surgery in case of a major accident or serious illness

or

2)      Comprehensive coverage to cover you for doctor visits, prescriptions and preventative care.

There are many plans to choose from with variations on coverage, deductibles and out of pocket.

Generally, high deductible plans have lower monthly premiums. You are basically betting you will not need to use the insurance but you have it if you need it.

Low deductible plans have higher monthly premiums because you are basically paying more up front for the coverage. These plans are available if you have a greater need to go to a specialist or frequent a primary care physician, need preventative care, tend to have more frequent prescription needs, etc.

As you work through the plans, you will need to consider how and where you can get the extra money for out of pocket and deductibles should you become ill and use the insurance.

As a young adult working through this process, think about your medical history:

  • Over the last year, do you feel you have been relatively healthy as compared to your peers?
  • How frequently have you gone to the doctor in the past two years?
  • Have you parted with your tonsils and appendix?
  • Do you stay current with annual immunizations through other resources such as pharmacies and convenient care clinics?
  • Do you have frequent upper respiratory or stomach infections or skin conditions requiring treatment?
  • Do you participate in higher-risk recreational activities such as skiing?
  • Do you plan to travel outside the country?
  • Are you frequently around people who may be sick or are contagious with illnesses that generally need formal medical treatment?

Next! Medical Insurance Dictionary

Medical Insurance 101: As a young adult – is it necessary?

The P-YA Conversation  

We are almost empty-nesters. Almost. The youngest has moved to the West Coast and the second may well be moving to the Upper Midwest or North West soon. Not to promote any political persuasion, but it has been nice keeping both boys on our insurance until the age of 26.

But, at some point, the birds leave the nest and they need to be prepared for the world. In prepping for the world, I have asked each of them about what they plan to do when they are sick in their respective new areas. I received the following reply, “I guess I will go to the ER.”

I try not to gasp and roll the eyes. Deep breath. Think fast. Respond slowly.

As a healthcare professional and a proponent of consumer accountability and cost containment, I was shocked at the response. We had not done our job of educating the kids on the health system – except to ask the question to get an idea of what they do know. Hmm. Not much knowledge. Much to do.

How does a parent translate the complexity of the healthcare system to a young adult who has never had to deal with health benefits? Always had mom and dad help with appointments, pay for co-pays, manage the deductibles and out of pockets, and of course, premiums? Have we been hover-parents and didn’t know it?

I honestly don’t remember my parents talking to me about medical insurance. My first job provided healthcare benefits back in the days before PPOs, EPOs, HMOs, HSAs and goodness, what other acronym can we create to make the learning more difficult but perhaps the care more affordable??

So here’s how the Parent – Young Adult conversation can go:

YA: I never get sick.

P: Yes, you are right. Young adults are relatively healthy. Your greatest risk is an accident.

YA: I drive safely.

P: You are involved with other activities that could involve accidents. Example: bicycle riding or hunting. It may not your fault. It could be the person you are with.

YA: I am careful. My friends are careful. It won’t happen to me.

P: I feel comfortable that you are as careful as you can be. But things happen. If you fall off your bike and injure your leg, just an ER visit to x-ray your leg, have a doctor evaluate you, give you some antibiotics and painkillers could be as high as $5000. Do you have $5000 in your bank account?

YA: No.

P: How would you pay for the bill?

YA: I can’t right now. I guess I could ask you for help.

(Try not to gasp and roll the eyes. Deep breath. Think fast. Respond slowly.)

P: What do you think will happen between you and the ER facility?

YA: I guess I will receive a bill.

P: Yes, and more than likely for the total amount. How will you pay the bill?

YA: I’ll try to pay it. Is it like a credit card?

P: Sort of. But it will take a long time to pay off $5000 on your salary.

YA: I guess I have never thought about.

P: Well, we really haven’t had a need to talk about it but I guess we do now. Insurance is created to provide some protection against the risk of an accident or illness that could financially deplete you. With insurance, although you pay monthly premiums, in most cases you won’t receive a bill for the total. It depends on what product you purchase. Given that with your first job you are making around $25K and it does not offer you healthcare insurance, basic healthcare insurance is an investment in your financial and health future.  We can look at your budget, look at the different insurance options, and choose one that is good fit for your needs and budget. Healthcare insurance should be a line item just like your cell phone bill and groceries. The good news is you are young and healthy and the premiums can be affordable. First, let’s look at some basic insurance language that will help better understand the products.  

Coming Next:

Truisms of Young Adult Healthcare Insurance

Medical insurance dictionary

What medical insurance options are available for young adults?

Woohoo! I have my first job with benefits. What does that mean and now what to I do?

Found Money

I love to find “money drops”  in our household processes.  “Money drops” are those processes that, if not reviewed at least annually, results in you insidiously dropping money throughout the year that could add up to hundreds of dollars that you can invest or use for other purchases. I earned $70 in Found Money last week. Here’s how:

“Money Drops”

Something jarred our brains to evaluate the homeowner’s insurance to verify if we receive a discount for the security alarm system. Sure enough, our homeowner’s insurance does have a 5% discount for a security alarm system. One may self-talk “5% is not worth the trouble to submit a certificate.” I guess it depends on what 5% is of what total amount. 5% of our homeowner’s insurance was $70. They sent us a check. I liked that. $70 pays for 1.25 months of the monthly alarm system fee. That’s OK. Moving forward, we will save money on the premium.

Here’s my thinking and probably many others out there. 5% on a restaurant bill doesn’t even take care of tax. But 5% of total purchases throughout the year could be hundreds of dollars if not more. We wouldn’t just drop $500 in a barrel and burn it.

Let’s say you have a household income of $40k. You have $30k in purchases/expenses capability. If you save 5% on everything for a year that is $1500/year. Now, in reality, that is not feasible because your mortgage or rent may be 50% of your buying power. But, if you strive to save 5% on half of those purchases, that is $750. Hmmm, that’s 75 bottles of wine… ok, let’s not be wine hoarders.

What would you do with $750? Invest? Go on vaca? Add to your kid’s college fund?

Have fun with your 5% action plan!

Next post: Money Opportunities

Breaking the JIC

As I was sweeping and mopping the kitchen floor early this morning, I realized as hard as my husband and I try, we still collect things – more importantly multiples of things. Things purchased because it was a BOGO offer so we have two bottles of Club Soda and two bottles of Tonic water lined up against the floor of the refrigerator. (they really do need to be moved to the garage for storage but that’s for another sharing…) Things we have collected or outgrown like the 2.5 sets of 5# weights. Yes, I am up to 8 lb weights and hopefully will be graduating to 10 lbs soon, but keeping the 5s, just in case….. Six individual casseroles for those six individual crepe servings I will probably never make for a dinner party but, just in case….

I only have two arms…what’s up with this?

My husband and I chose to stay in our 1465 square foot, 1952 year model house (it’s 70 years old!) rather than move into a larger house. Over the last five years we have done some minor upgrades to the windows, kitchen and landscaping but no additional square footage. We are empty nesters and thought a lot about whether to graduate to a different house, maybe one with a third bedroom but the reality is, when we have company, we use just the one extra bedroom. We have our long-term retirement goals which do include a slightly larger house but at this point, we are committed to making a house that is 70% the size of the average single family home in 2009 work for us. So we have to manage “collections” and stuff. And we have to develop good decision making skills on the “just in case” (JIC) collections.

What helps me break through the JIC is to ask myself the following steps and process questions:

1) Have you used these items in the last two years? If not, list all the reasons why you have not used the item.

2) How many opportunities have you had in the last two years to use these items and forgot to use or chose not to use?

3) What is the probability to use these items in the next year (smaller time frame)?

4) Is the probability an pre-contemplated active choice  or an opportunity by chance or luck? (Probability may vary. For the weights, because we are getting a little older, there may be a probability we get sick and have to rebuild upper body strength so it may be good idea to keep one set. For the the casseroles though, lower probability unless I make an active choice to use.)

5) Is the space allocated for the item adequate?

6) If you give away or donate, is it cost-prohibitive to replace?

7) If you give away or donate, can you improvise with another item?

8) If you give away or donate, will you REALLY be negatively harmed in some manner (emotionally, spiritually, physically, etc.)?

9) How much pleasure would you feel if someone else got use out of the item?

10) What is the final space value and probability to keep?

Low -1 Medium -2 High – 3 Very High -4 Total Value Scores Highest Possible Score Probability of Keeping
Probability of Use 2 2.00
Level of Importance to your lifestyle 2 2.00
Final Score 4.00 8 50%

Start small. Focus on the items scoring 50% or less. As you build courage and resilience, and yes, it does take courage and resilience, move to 75%.

Au Revoir, Good bye and Auf Wiedersehen weights and casseroles!

A Summer Treat – Emerald Pluot Jam

One of the main purposes of this project is to share ideas in managing the home in an efficient yet pleasing manner. I admit- I enjoy food. The foods we have available to us now are absolutely amazing and growers/hybridists (is there such a word?) are creating some of the most beautiful, tasty fruit in the plum/apricot family.

Honestly, I haven’t always been a plum girl – always reminded me of the basic purples I grew up with. But who knew there ever be gorgeous emeralds, mangos and pomepluots to choose from? So, although still working on my self-control factor, the plums lay there in all their glory in the fruit bins, calling to me to buy not one, but four. And then I go to Savannah for a speaking engagement and three are left in the basket to ripen very nicely over five days.

What to do? Don’t want to waste them. Can’t eat them all in one day ( could but I have to watch my daily fruit intake.) I wish to enjoy them in some manner so using the rapid cycle process improvement or idea generation technique, try something interesting with one pluot. If it works, try with a larger batch.

I love jam. I don’t eat a toasted item everyday for breakfast so a jar lasts quite a long time. I’ve been known in my past life to make too many jars of jams that go to waste because two people in a household really don’t need to eat  12 jars of raspberry and 10 jars of blackberry rosemary jam and one only has so many friends to give them away to. So, for small households, let’s try one jar at a time. Savor the “fruit” of summer.

Single Pluot Jam

One ripe emerald pluot

1-3 tsps of sugar to your taste

2 tsp water (a small splash if you don’t feel like measuring)

One quick squeeze of a lemon slice (not too much. You want the taste of the pluot, not the lemon. This is just to brighten the flavor and preserve the color. If you are the measuring sort, 1/8 tsp is enough.)

Peel, half and  pit the pluot. (Don’t sweat the peel too much. It will slide off during cooking.) This is supposed to be easy, enjoyable and creating a controlled amount to enjoy. Slice and coarsely chop the pluot and put in a small saucepan.

Add 1 tsp of sugar initial and the water. Simmer the mixture on medium for 10 minutes. Stir occasionally and watch to  make sure it doesn’t burn. Taste occasionally and add 1-2 tsps of sugar to your taste and to manage the tart/sweet nature of your pluot.

Keep simmering until the mixture thickens as the sugar will carmelize, the water content reduces and your jam is transforming to a thick, sticky consistency that will be spreadable but not runny.

Pls, no comments about my pot. 🙂 It’s the BEST pot!

Cool, jar and refrigerate. Enjoy!

Any more jam would be too much