Health Insurance: What You Need to Know

About Your Health Insurance

• Health insurance allows you to get the medical care you need. You can get health insurance through your job or through the state you live in.
• It is good to have health insurance even if you are healthy. Health insurance helps you pay for doctor’s visits if you are sick or hurt. It also helps you pay for tests or surgery. Without health insurance, your medical care will be very expensive.
• The new laws in your state say that everyone must have health insurance or you will pay a fine (money paid to the court).

About Your Health Insurance Card

• When you get health insurance, you will have a health insurance card. Bring this card with you to every doctor’s appointment.
• This card tells your doctor important information, like co-pay amounts (how much you pay for doctor’s visits) and your unique policy number (the number that tells health insurance companies who you are).

About the Explanation of Benefits (EOB)

• A few weeks after the doctor’s appointment, you will get an explanation of benefits (EOB) in the mail. The EOB tells you about the care you received. It also tells you how much your health insurance company paid for that care.
• The EOB is not a bill.
• It is a good idea to keep your EOBs somewhere you will remember them.

About Medical Bills

• Medical bills come in the mail a few weeks after you receive your EOB. The medical bill tells you how much money you owe to your health insurance company.
• Medical bills come from your doctor’s office or hospital. But you can call your health insurance company if you have questions about the bill.

Common Questions About Health Insurance

• What is my health insurance network?
  Your insurance network is a group of doctors who accept your health insurance. This group of doctors are called in-network doctors. If you go to a doctor who does not accept your insurance (out-of-network doctor), your medical care will cost more money.
• What are co-pays and co-insurances?
  Co-pays and co-insurances are amounts that your health insurance company expects you to pay for doctor’s visits, hospital stays and medications. Your co-pay usually costs less money if you follow the rules from your health insurance company.
• What should I do if I change my doctor?
  Co-pays and co-insurances are amounts that your health insurance company expects you to pay for doctor’s visits, hospital stays and medications. Your co-pay usually costs less money if you follow the rules from your health insurance company.
• Can my health insurance change?
  Yes. It depends on your age, job and whether you are in school. It also depends on your family members and how much money you make. Some health insurance companies want you to tell them whether you are keeping your insurance every year. They might also want you to update information like your name or address.

Where Can I Learn More?

• The Down Syndrome Program at MGfC and Mass General
• Your health insurance company's website

Health insurance basics

Answer the questions below so you can learn the basics about your health insurance. Circle or fill in your answers.

Do I have health insurance?

Yes

No

Is my health insurance through my job, my family or the state I live in?

My job

My family

My state

The name of my health insurance is:

_________________________________________

The phone number for my health insurance is:

_________________________________________

My health insurance policy number is

_________________________________________

My health insurance will change if I

Get a job

Turn 19

Turn 26

Earn more money

Go to college

Move to a different state

Get married

Other reason: ____________________________