Connecting to Care and Services

No one plans to get sick or hurt, but accidents happen. Health insurance helps cover the costs of treatment, and sometimes it even helps you get services you couldn’t get otherwise.

Some of the benefits offered by health insurance:

1. Care before and after your baby is born.
2. Lab tests.
3. Preventive services, such as counseling, screening, and vaccines.
4. Outpatient or clinic care.
5. Emergency room care.
6. Treatment in the hospital.
7. Mental health and substance use services.
8. Prescription medications.
9. Services and equipment to help recover from an injury or aid with a disability.
10. Avoiding the federal fee for not having health insurance, which is 2.5% of your household income or $695 per adult.

The Health Insurance Marketplace is a new way to find health care coverage:

1. Helps you find health insurance that fits within your budget and helps you pay for your insurance if you have trouble affording it.
2. Lets you know if you or your child qualify for free or low-cost programs, such as Medicaid and Children’s Health Insurance Program (CHIP).
3. Can help you get insurance with the three private insurance carriers in North Dakota – Blue Cross Blue Shield North Dakota, Medica, and Sanford Health.

Five things to ask about health insurance:

1. What does your insurance offer? Different insurance plans have different benefits. A good plan covers most or all of the benefits listed above.
2. Is there a co-pay? Most insurances have co-pays, or amounts of money you pay out of pocket at the time of your appointment. This is usually a set dollar amount, depending on the type of appointment you have.
3. What is your deductible? A deductible is an amount of money that you have to pay each year before your insurance starts paying. For example, if you have a $200 deductible, you are responsible to pay $200, and then your insurance starts to pay. (You can usually be billed for the deductible. For instance, you don’t necessarily have to pay the full $200 before your insurance starts paying; the deductible is just the amount that you are responsible to cover.)
4. Does your provider work with a specific network? Depending on your insurance plan, you may get more benefit from your plan at certain hospitals or clinics. Your insurance may still cover some care at “out of network” facilities, but not as much as a place that is “in network.”
5. Are you getting full or partial coverage? Some insurance plans only offer assistance if you are injured in an accident. Others offer full coverage, which means you are covered for preventative care, too.

Three things to know if you qualify for IHS (Indian Health Services):

1. Even if you have other insurance, you still have a right to use IHS services as you need them.
2. The new healthcare law requires everybody, even people who qualify for IHS, to have basic insurance coverage. This means signing up for a basic insurance policy, like private insurance or Medicaid. The Health Insurance Marketplace can help you find and pay for a health insurance plan.
3. When you have health insurance (either private or Medicaid), it’s easier to get services at non-IHS facilities when you need them. It’s also easier to get services that IHS doesn’t offer.