COLUMBIA — A trip to the emergency room was not in her plans for the night, nor was the ensuing bill in her budget.
Jordan Burford, 20, knew she had a sinus infection and was at work that March night when her throat started to swell. She was having trouble breathing and took herself to the hospital.
Here's a list of health insurance terms you might need to know.
- Coinsurance: your share of costs for a health care service, usually a percentage of the total charge. Consumers pay coinsurance and any owed deductibles. For example, if the deductible was already paid, your coinsurance was 20 percent and the total bill was $100, you'd pay $20 and your insurance would pay $80.
- Copayment: the fixed amount you pay for a received service or when filling a prescription. The amount can vary by service, but there is a set maximum amount with each insurance plan. For example, a doctor's visit may have a copay of $20, but an emergency room visit will have a higher copay.
- Deductible: the amount you pay for health care services before the insurance plan covers it. For example, if a person has a $1,000 deductible, he or she pays up to that amount over the course of one year, regardless of how many times he or she visits the doctor, before the insurance company picks up the tab.
- Health Insurance Marketplace: the federally operated online marketplace where consumers can buy health insurance. The marketplace allows you to compare different health plans provided by private insurance companies.
- In-network provider: the doctors or facilities that accept your insurance policy. The network is different for each insurance plan but can be usually viewed on the back of an insurance card or by looking at the insurance company's website.
- Premium: the amount paid monthly, quarterly, or yearly for an insurance policy.
"I was just really sick and couldn't go to the doctor," Burford said. "So I ended up having to go the E.R."
She was discharged from the hospital on March 2 after a bevy of tests, including blood tests, a throat swab and bronchoscopy. The results: Burford had a bacterial infection in her lymph glands and was placed on antibiotics and a small dose of steroids.
The consequences of that single night in the hospital were bills totaling about $2,500. Burford said she was overwhelmed at the thought of paying them out-of-pocket. The Moberly Area Community College student lost her health insurance at the end of last year when her father lost his job.
She is one of many young, uninsured Missouri residents. But her hospital visit changed her mind about the importance of health insurance.
Current estimates of the number of uninsured people aren't available because the data are based on year-old results, said Ryan Barker, vice president of health policy for the Missouri Foundation for Health. According to the U.S. Department of Health and Human Services, only 30 percent of Missouri residents who bought insurance through the Health Insurance Marketplace were ages 18 to 34.
That poses a problem because, according to Gallup research, 40percent of people newly enrolled in the marketplace for the Affordable Care Act need to be young and healthy so that premiums remain low.
Barker said young people who didn't buy insurance may not understand the law and language related to health insurance.
For example, Barker said, many people don't understand what a deductible is and how it differs in health insurance from auto insurance.
"Health insurance is a pretty complicated topic. Those of us that are even pretty well versed in this stuff have some trouble understanding some of the benefits," Barker said. "So someone without health literacy is going to struggle even more."
Barker said that people who have never had insurance or have been uninsured for a long time have a tough time understanding the terms.
To counter that, the Missouri Foundation for Health awarded a nearly $500,000 grant in April to Health Literacy Missouri that will be used to help Missouri residents understand health insurance, said Michelle Roberts, director of communications, strategy and market research for Health Literacy Missouri.
Roberts said she hoped the grant money would help increase health insurance literacy throughout the state. It will be used to create a series of videos in different languages and to revise already existing materials from Cover Missouri.
"We'll be editing those for plain language and making sure they're understandable," Roberts said.
Barker said part of the initiative would include helping consumers decide how to pick an insurance plan, along with teaching them what the plans mean and how to use the insurance. Navigators are working alongside Cover Missouri to help people with this process.
One of the challenges, said state Rep. Chris Kelly, D-Columbia, is that young people don't feel the information pertains to them.
"There's a lack of information because young people don't look for the information," Kelly said. "They're immortal, and they don't have kids yet."
Barker said that these "young invincibles" often don't think they're going to be sick or in an accident — although not all young people fit that description.
After Burford's unexpected trip to the hospital and subsequent bills, the search for a solution isn't over. She's been trying to educate herself about insurance and looking for the best policy for her lifestyle.
While she is still uninsured five months later, Burford said buying health insurance is extremely important to her.
"Finding a good insurance plan is at the top of my to-do list as soon as my summer vacation begins," she said.
Supervising editor is Katherine Reed.