by: Parent Project Muscular Dystrophy
Navigating insurance can be daunting – from decoding acronyms, to understanding the types of health plans, and more. During September’s Advocating for Access webinar, the PPMD and Little Hercules Foundation teams dug into some of these elusive terms and demystified their meanings, and how to navigate understanding a choosing a health plan.
PPMD’s Brian Denger provided an overview of managed care and high deductible health plans, including common acronyms you might hear when talking about insurance, and what they mean. He highlighted the roles and interactions of private insurance plans, high deductible plans, and how Medicaid plans – also known as managed care organizations, interact with these types of insurance coverage.
Following this overview, Little Hercules Foundation’s Kelly Maynard described the differences between fully insured vs. self insured plans: While medical costs incurred through fully insured plans are paid for by the health insurance company, with a self-insured plan, the insurance provider manages claims and advises the employer on coverage decisions, but the employer is responsible for paying the costs incurred for medical services rendered. However, to help cover the high cost of some services and drugs, many self insured plans have reinsurance (also known as stop-loss coverage), which helps to cover unexpectedly high medical or pharmacy costs. Since it’s not always clear whether your plan is fully insured or self insured, you should contact whoever manages your employee benefits – which is frequently an HR department – to ask them directly about what type of coverage you have.
Do you have questions about your policy, health insurance acronyms, or want help navigating your insurance? Check out PPMD’s Access and Coverage Resources for New Therapies, which includes a library of resources to help you navigate insurance and your benefits. Additional resources that may be helpful in understanding insurance include The PACER Center and The Kaiser Family Foundation.
You can also schedule time with the PPMD Team directly through our PPMD For You platform, or email the Duchenne Family Assistance Program at info@duchennefap.org. And, as always, if you have other questions, send them our way at careteam@parentprojectmd.org. The October installment of the Advocating for Access webinar series is scheduled for Thursday, October 26, 2023 at 1:00pm ET.
