A Guide to Signing Up for Health Coverage
Deductibles. Drug formularies. Not to mention a health insurance option — Cobra — that evokes a deadly reptile.
Just reading arcane health insurance terms can induce a rare combination of drowsiness and panic. Yet health coverage is an important part of consumers’ personal finances. Right now, many are facing the task of parsing those terms, as deadlines approach to enroll in coverage next year under the Affordable Care Act.
That is why a 30-minute YouTube video on health insurance terms by Brian David Gilbert may prove helpful. Mr. Gilbert is a self-described “writer, actor, musician and video producer.”
The video, “A terrible guide to the terrible terminology of U.S. health insurance,” is a departure for Mr. Gilbert. He had previously used his geeky sense of humor to create goofy online productions (like one featuring himself as a werewolf, singing a parody of a Bee Gees hit).
The health video is silly, but useful. “The best video about health insurance ever,” declared “An Arm and a Leg,” a podcast about the high cost of health care produced with help from Kaiser Health News, a nonprofit newsroom.
In his video, Mr. Gilbert stages a parody game show called “Gamble on Your Health,” starring himself as both host and player, to illustrate the downside of a health plan with a low monthly fee but a high deductible — the amount you must pay before your insurance pays.
As a contestant, Mr. Gilbert bets that he will remain healthy and is giddy to learn that his choice of a high-deductible plan will save money. But in a celebratory spasm, he falls and breaks his leg. “Seems like you’ll be paying that high deductible at high speed,” Mr. Gilbert, the host, crows. “Ha ha!”
Mr. Gilbert, 28, said in an interview that the idea for the video began in late 2020, when he left a job with health benefits (he produced videos for Polygon, Vox Media’s video game website) to work as a freelancer. He was overwhelmed by the process of selecting a plan on HealthCare.gov, the federal insurance marketplace, with its myriad silver, gold and platinum options.
“I kind of shut down,” Mr. Gilbert said. Everything about health insurance, he said, seemed opaque and confusing.
He chose instead to continue coverage under Cobra — the Consolidated Omnibus Budget Reconciliation Act. The decades-old law lets people continue workplace health coverage for up to 18 months after leaving a job. But there’s a catch: You must pay the employer’s share of the monthly premium plus your own. So it’s typically expensive, Mr. Gilbert says in the video, admitting that he was a “big dummy” for using it.
Earlier this year, as Mr. Gilbert’s Cobra coverage was close to expiring, he reluctantly ventured back to the insurance marketplace and, after a week or so of reading documents, chose a health maintenance organization. The H.M.O. saves him about $200 a month — but offers less flexibility in choosing doctors than his former plan, a preferred provider organization, or P.P.O.
After that, he figured, he had “a basic understanding of health insurance,” so why not produce a video to help others? (In the video, after discussing P.P.O.s, H.M.O.s, and H.D.H.P.s — high deductible health plans — Mr. Gilbert smiles faintly. “Every word in that sentence,” he says, “burned as it came out of my mouth.”)
He expected to spend perhaps a month doing “a quick, eight-minute video.” But, this being health insurance, he kept learning of exceptions and caveats that required explanation, so the project stretched to four months. Since he isn’t an expert, he said, he stuck to translating terminology and sent a rough cut to supporters, some of whom have health insurance expertise, for accuracy and feedback. (Mr. Gilbert said he earns payments from patrons via the crowdfunding site Patreon and from ads that run with his YouTube videos. He said he wasn’t paid by health insurers.)
Mr. Gilbert said he’d been pleased that people have been watching the video, but stressed that he was not an insurance guru. Based on his experience, though, he offered this advice: “Focus on the thing most necessary for you and make sure that the plan deals with that really, really well.”
While the video is largely accurate in its descriptions, a segment on the unexpected bills that patients sometimes get for emergency room visits warrants an update (which Mr. Gilbert acknowledges in a comment on YouTube). The No Surprises Act, a law that took effect in January, enacted new rules to protect consumers against surprise bills for out-of-network treatment at emergency rooms.
Here are some questions and answers about health insurance:
When does open enrollment end for marketplace plans?
The HealthCare.gov deadline for coverage that starts on Jan. 1 is Dec. 15. (You can enroll until Jan. 15, but your coverage won’t start until February.) Seventeen states and the District of Columbia run their own exchanges and may have different deadlines. If you miss a deadline, you may qualify for a “special” enrollment period if you get married or lose your job. And some low-income people can enroll in marketplace plans anytime. Consumers can get assistance in choosing a plan by clicking on “find local help” on HealthCare.gov.
How do I know whether to go to HealthCare.gov or a state marketplace?
Dan Weissmann, a journalist and host of “An Arm and a Leg,” suggests going directly to HealthCare.gov. The federal marketplace will direct you to the appropriate state version, if needed. Don’t simply search online for “Obamacare,” he said, because you will get links that may look legitimate, but may not be. The podcast also offers a newsletter with advice for choosing a plan.
How much does a marketplace plan cost?
It varies, but expanded federal financial help with premiums has been extended through 2025, so most people buying marketplace coverage qualify for subsidies that lower their costs. Most customers can find plans on HealthCare.gov for $10 per month or less, after tax credits, according to the federal government.