1. If you choose a plan with lower premiums, you’ll end up paying more when you need care, through higher deductibles and cost sharing. You’ll also likely have fewer providers to choose from.
2. If you got insurance through your employer, you probably didn’t get a lot of choices. Employers generally offer two or three plans; by comparison, the Affordable Care Act’s health insurance marketplace offered the average Kansan 25 to 30 plan options.
3. Insurance is a way to protect against risk. Medical bills are the leading cause of bankruptcy in America.
4. Not every doctor or hospital is covered by every plan. Insurance plans increasingly have narrow networks, in which only certain physicians or hospitals are covered. Beneficiaries pay a higher rate for doctors who are out of network.
5. Preventive services are free. The Affordable Care Act required that health plans completely cover screenings such as routine blood work, pap smears and mammograms.
6. If you have any doubt about whether your plan covers a certain service or doctor, call your insurer to make sure. Otherwise, you risk being responsible for 100 percent of the costs.
7. The more you pay up front, the less you will generally pay later on. Plans with lower deductibles require more spending at the start but less when you actually utilize services.
8. The employer-based health insurance model started as a way to attract and retain good workers. “It was a recruitment tool that evolved during World War II, when we had wage freezes and employers couldn’t give more money to their employees,” said Roberta Riportella, a professor of community health at Kansas State University.
9. Most people don’t need as much insurance as they have. When Americans purchase insurance, which most of them are now required to do, they become part of a pool in which risk is spread among all the beneficiaries. However, a small percentage of people account for most of the health care spending in the United States.
10. Health insurance literacy isn’t an issue in countries with nationalized health care systems. People in countries like Canada and Great Britain go to a doctor or hospital, and the government pays for it.
11. The price of a service is often completely different from what you and your insurer end up paying. Medical groups often negotiate contracts with insurers to cover their services at discounted rates.
12. Cosmetic procedures, like plastic surgery, are rarely covered by insurance.
13. To understand health insurance, you must first know the basic terminology:

• Premium: How much you pay for the plan, generally on a monthly basis

• Deductible: How much you pay for covered services before your insurance kicks in

• Copay: How much you pay for a given doctor visit or prescription medication

• Coinsurance: How much you pay for a given service after your deductible has been met

• Cost sharing: Your total out-of-pocket costs (deductible, coinsurance, copays, etc.)

• Out-of-pocket maximum: Under the Affordable Care Act, the most you can pay out of pocket in a given year is $6,350 for an individual or $12,700 for a family.

• Network: Which doctors and hospitals your plan covers

• Benefits: Which services your plan covers

• Preauthorization: When you have to notify your insurer before undergoing a certain service or procedure; oftentimes, doctors’ offices take care of this for you

Sources: Kansas Insurance Department, Kansas State University, Lawrence Memorial Hospital, Kansas Association for the Medically Underserved, Kansas Health Reform Resource Project, Blue Cross Blue Shield of Kansas