What is Health Insurance

Hormonally cannot stress this enough – always read
the small print.

What is Health
Insurance?

Hormonally cannot stress this enough – always read the small print.

Navigate to the next section

What is Health
Insurance?

Hormonally cannot stress this enough – always read the small print.

Health insurance is a form of financial support that helps you to pay for medical and surgical expenses. Essentially, it’s a contract between you (or sometimes a group of people) and an insurance company. The company (insurer) agrees to help you pay for high medical costs so long as you have continued to pay your regular premium.

When it comes to insurance, you always have to pay a premium. Your premium is usually paid monthly, directly to the insurer. Your health insurance policy will typically cover some of your medical expenses but not necessarily all of your costs. This is really important to remember as lot’s of people find themselves in a difficult situation thinking certain healthcare costs would be covered under their insurance package, before later finding out these costs were not included. Hormonally cannot stress this enough – always read the small print.

Whilst it may be true there is no such thing as a free lunch there are ways to grab an early bird special. Options such as couponing can be a great way to help with the cost of treatments and your doctor will be able to tell you more about this. In your appointment, be sure to ask your healthcare provider for information about this if they are recommending a medication or treatment that is more expensive than you budgeted for. It may be more affordable than you first think.

At Hormonally we believe access to healthcare should be a right not a privilege. We want to do everything we can to help you feel supported when it comes to navigating the tricky terrain of health care insurance.

We feel the best way we can support the hormone ally community is to share your experiences and learn from them. So, if you have stories about insurance coverage (good OR bad) we want to hear them.

  • Did you struggle to seek out an STI solution on your plan?
  • Did you find your bleeding was barely on your insurers radar?

Whatever the issue, we want to know. Together, we can raise the roof (and hopefully) improve the plans that are accessible to women navigating their hormonal health issues.

scroll for more information

Further reading

Health insurance essentials

Talking to my doctor

Help spread the knowledge

Hormonally cannot stress this enough – always read the small print.

The key components and features of health insurance to get familiar with are:

Premiums

You, the policyholder (or employer, in the case of employer-sponsored plans) pays regular premiums to the insurance company. These payments are usually made monthly and are a fundamental part of maintaining insurance coverage.

Deductibles

The deductible is the amount you must pay out of pocket before the insurance company begins to cover certain medical expenses. Once your deductible is met, the insurance plan typically starts covering a percentage of your costs. Remember, it typically does not cover all costs.

Co-payments and Co-insurance

After meeting your deductible, you may still be responsible for co-payments or co-insurance. These are additional out-of-pocket expenses for specific services or prescriptions.

  • Co-payments are fixed amounts.
  • Co-insurance is a percentage of the total cost.

Networks

Health insurance plans often have networks of healthcare providers, including doctors, hospitals, and clinics. Using in-network providers usually results in lower out-of-pocket costs, while going to out-of-network providers can lead to higher expenses or limit what coverage you receive.

Insurance Coverage Types

  • Individual and Family Plans: Insurance coverage will cover your costs and your families costs.
  • Employer Sponsored Plans: Insurance provided by an employer to an employee and, in some cases, an employee’s family members.
  • Government Programs: These are programs such as Medicaid and the Children’s Health Insurance Program (CHIP) that are designed to provide coverage to those who are earning less than the average US citizen. These programs may also provide coverage for family members.

Essential Health Benefits

Under the Affordable Care Act (ACA), health insurance plans are required to cover essential health benefits, including preventive services, prescription drugs, maternity care, and mental health services.

Open Enrollment

There is typically an annual open enrollment period during which you can enroll in or make changes to your health insurance plans. Special Enrollment Periods (SEPs) may be available for certain life events too.

What does it do?

Health insurance helps to protect you and your family from the potentially high costs of medical care. When used effectively it can promote better access to healthcare services, preventive care, and equally support you to manage the financial risks associated with unexpected health costs. Hormonally understands that the specifics of health insurance plans can vary widely and that paying an insurance premium is not an accessible option for many people.

There is support and help available to you if you are struggling to afford healthcare insurance, or your employers do not offer insurance coverage as part of your employment benefits. Check out the Hormonally resource on Health Insurance Essentials where we signpost to reliable organizations that can help you to make the most of your coverage.

Deciding on a health insurance plan can be overwhelming. Many women opt not to seek care and support for hormonal issues as a consequence of fearing their insurance would not cover the costs. In situations where an insurance deductible would otherwise not be met, seeking care can often be ‘tabled’. Hormonally would urge you to prioritise your hormonal health as much as you can. Many plans do offer support and it’s a case of asking the question.

When it comes to your policy, explore and review your plan details and try to choose coverage that aligns with your healthcare needs and budget. If a particular hormone related ‘cost’ may be coming up (such as having an IUD fitted or starting Hormone Therapy) discuss this with both your clinician and your insurance provider to see what the best way of covering the costs would be.

Don’t forget we want to hear about your experiences and would love to hear from you so get in touch.

We need your help

Find out how you can support us