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Health

Insurance

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A COSTLY BIKE RIDE:

You’re out riding a bike with a friend
A little kid runs out in front of your bike
You brake and go flying
You and your friend rush �to the emergency room

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A QUESTION FOR EVERYONE

How much do you think this emergency room visit for a broken arm costs without health insurance?

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$21,000

How could a broken arm cost so much?

Initial Evaluation

X-rays

Emergency Room Overnight Stay

Your Cast or Sling

Anesthesia for Your Surgery

Surgery on Your Arm

Average Costs�in NYC

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The cost of your broken arm in this example: $21,000.

[Source: Aflac estimates a broken arm surgery costs anywhere from $17,150 to $31,000, so we took a number between those two. Further data on this slide shows how you might reach that specific number.]

So, you might be wondering: how is that possible?

Let’s start by looking at the costs associated with fixing your broken arm. What are some of the costs associated with fixing a broken arm?

[Field answers from students, then click to show a list of costs. Items populate one-by-one.]

This slide shows the various medical costs that might result from breaking your arm.

You need to get evaluated in the ER.

They take x-rays to see where the break is.

You have to stay overnight in the ER.

For your surgery, you need anesthesia and then you need the surgery itself. We’re talking about paying the doctors and nurses for the time they spend fixing your arm.

And eventually you leave with a cast.

So that’s a lot of different things, and each one has its own cost.

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$300

$2,500

$3,500

$5,000

$8,200

$1,500

Initial Evaluation

X-rays

Emergency Room Overnight Stay

Your Cast or Sling

Anesthesia for Your Surgery

Surgery on Your Arm

$21,000

How could a broken arm cost so much?

Average Costs�in NYC

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THE GOOD NEWS: IF YOU HAVE HEALTH INSURANCE, YOU DON’T ACTUALLY HAVE TO PAY THAT MUCH.

How much do you �think a broken arm will cost if you DO have health insurance?

$21,000

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Major accidents or illnesses
Annual medical checkups, dental cleanings, �and vision tests
Prescriptions and ongoing expenses for �chronic conditions like asthma or allergies
Sometimes even mental healthcare and �physical therapy

Health insurance pays for most of the �cost of:

$21,000

$0 - $2,000

If you have health insurance, you don’t have to pay the full cost on your own.

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If you have health insurance, you pay much less than the full cost.

[Click to reveal true costs to you if you have health insurance.]

So in this situation, a typical NYC family with health insurance would end up paying anywhere from zero dollars to about $2,000, rather than the full $21,000, for your broken arm.

[Sources for this range: NY average broken arm cost, with insurance, is $765, per here; this assumes going to urgent care and not to an emergency room. An emergency room will be more expensive, and will likely require you to pay out your full deductible. The average deductible for NY employer plans is $1,859 per here.]

[Click to reveal the list of what health insurance covers a large part of the cost of.]

Health insurance helps you cover a large part of the everyday medical costs you might have to pay for on your own.

It helps pay for most of the cost of your injuries and recovery if you have a major accident or are hit by a major illness.

It tends to pay for much of the cost of annual checkups for your overall health, your teeth, and your eyesight.

It usually pays for a portion of the cost of medical prescriptions you need as well as ongoing medications for conditions like asthma or allergies.

Depending on the type of health insurance you have, it may cover part of your mental health expenses, if you see a therapist or psychologist, for example, as well as costs for physical therapy.

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THE THREE WAYS YOU PAY FOR HEALTH INSURANCE

PREMIUM

DEDUCTIBLE

COPAYS

The monthly cost you pay, whether you use your insurance or not

The annual amount you pay before insurance starts to pay

The small amount you pay each time you see a doctor/get meds; does not count toward deductible

$0-$500 / month�(up to $6,000 per year)

$1,000 per year

$25 / doctor’s visit

$50 / Urgent Care

$250 / ER visit

$10 / prescription

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So, the roughly $2,000 or so you would pay in our broken arm example is of course a lot less expensive than the actual $21,000 worth of bills you’d be likely expected to pay if you didn’t have health insurance. Which is great.

But that’s not the whole story. It’s important to understand that health insurance isn’t free: It will cost you money.

We’re going to run through those costs. I want to warn you that the terms used in the health insurance world are really technical-sounding -- and can be hard to remember. So as I describe them, I’d like you to write them down in the chart on your worksheet, in the area called “The Cost of Health Insurance.”

First there is the premium. That’s a set dollar amount that you pay every month.

So if you were buying health insurance in New York, it costs $123 a month on average. Per year, that would be $1,476. [Source.]

What you pay depends upon your job and employer.

As a NYC teacher, for example, you can sign up for a $0/premium plan. [Source.]

One thing that’s clear: getting health insurance from an employer is often your most affordable option.

The next type of expense you pay when you have health insurance is called the deductible.

This is a set amount of money that you need to pay before insurance starts to cover you.

For instance, a typical plan might have a deductible of $1,000. So in the case of the broken arm, you would have to pay your full $1,000 deductible before your insurance kicks in to cover the rest.

[Source: KFF Healthcare Summary: The average deductible amount in 2024 for workers with single coverage and a general annual deductible is $1,787. Further note: In the Obamacare/Marketplace plans, this deductible can range ranging from $200 to $4,600. S o urce quotes rates for NY Bronze, Silver, Gold, and Platinum plans, low end is $0 and high end is $4,600.]

The final expense you need to know is called the copay. Each time you visit a doctor or go to the pharmacy to get medicine, you usually have to pay a set fee -- it’s a copay of about $25 in the case of the doctor’s visit, and $10 for the medicine.

[S ource; also see NY Essential Plan cost sharing schedule here. Urgent Care copay was also informed by data from here.]

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IS HEALTH INSURANCE WORTH IT?

Let’s watch �two opinions on this question.

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So on the one hand, we’ve seen how health insurance can save you money, but on the other hand, it also costs you money. Based on all that:

Do you think it’s worth it for people your age to get health insurance? Let’s see a show of hands.

Now tell me your reasons. Those of you who said yes, why is this? And those of you who think it’s not worth it, why is that?

[Field answers/have discussion on this topic. Possible discussion prompts:

You might think you don’t need health insurance because…

I’m young and healthy.

I’m really safe.

I don’t ever get sick.

I think the insurance industry is corrupt.

I don’t play sports.

It’s too expensive.

You might think you do need health insurance because…

You never know what bad things can happen.

You have had an experience when a friend or relative got sick, and you’ve seen that health insurance really made a difference in that it helped the person afford good care.

Even if I’m not sick now, I could get some disease.

A dumb accident could end up costing me big time.

If I had to go to the hospital without insurance, I might end up paying that back for a decade.]

Now we’re going to look at different perspectives from two people online. In this first example, the young person is assuming her health insurance premium is $500 a month -- or $6,000 a year -- which the high end of what insurance tends to cost.

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IS HEALTH INSURANCE WORTH IT?

Let’s watch �two opinions on this question.

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How likely are these?

a)	18%	of people will go to the ER this year
b)	2.3%	of people will break a bone this year
c)	86%	of women 44 or younger have a baby
d)	17%	of people have committed insurance fraud (which is a crime)
e)	66.5%	of bankruptcies are a result of medical bills

66.5%

18%

2.3%

86%

17%

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OK, so we’ve heard some opinions on both sides. Now let’s take a look at some facts about the different types of medical situations you might face.

We’re going to to do this activity using your worksheets. On the left there is a list of the medical problems, situations or treatments that you might encounter; on the right are the percentage of people in the US who have those issues or treatments. Take some time and match them up on your worksheet -- which percentage on the right goes with which item on the left?

[Allow time for work, then ask class to share answers/thoughts.]

[Then Click to reveal correct answers, and share these facts in further discussion.]

18% of people go to the ER each year. (Put another way, that’s nearly one in five people each year!) And going to the ER is much, much more common in a city like New York. [Source for 18%.]

There’s a 2.3% chance you break a bone this year. (And one estimate says that every person breaks an average of two bones in their lifetime.) [Source for 2.3%; Source for two bones.]

86% of women age 44 or younger have a baby–and that almost always happens in a hospital. [Source.]

17% of people have committed insurance fraud. This is a crime, and you can go to jail or face steep fines for trying to deceive insurance companies. [Source.]

And here is something to consider: Most people who file for bankruptcy do so as a result of being hit with big medical bills they can’t afford to pay. (The exact figure: 67% of people who go bankrupt cite medical bills as the primary cause. And more than half a million people file for bankruptcy each year for this reason.) [Source.]

The point is, medical issues can end up costing thousands of dollars. The only way to protect yourself: Get health insurance.

And as we know from the the Credit lesson, if you have trouble making timely payments on your medical debt, you’ll end up with a lower credit score, and as a result lenders will charge you higher interest rates on car loans, home loans, etc. And that will cost you a lot of money over your lifetime.

More than 14 million adults (6% of the population) are in serious medical debt in the U.S. [Source.]

The bottom line: You need health insurance.

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Most of you get health insurance from your parents in 1 of 3 ways:

THROUGH YOUR �PARENTS’ EMPLOYER

THROUGH YOUR PARENTS’ OBAMACARE/MARKETPLACE PLAN

THROUGH MEDICAID/CHIP

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The good news: Pretty much everyone in this room has health insurance.

In fact, 97% of kids in New York have health coverage. [Source: Only 2.7% of NY children are uninsured, per Georgetown analysis.]

In general, you get health insurance through your parents -- and they get it in one of three ways.

[Click to show “how parents get health insurance” options, which reveal one-by-one]

Through their Work. Many parents get health insurance coverage from their employer. [Source: KFF.]

Through the Obamacare Marketplace. If your parents don’t get health insurance from their job, they might get it through what’s called the “Marketplace,” which is a government-run site that allows them to buy individual coverage at more affordable prices than what they could find on their own. This Marketplace is also known as Obamacare or the Affordable Care Act Marketplace. [Source: Healthcare.gov .]

Through government programs such as Medicaid or CHIP, which stands for the Children’s Health Insurance Program. Both of these are government programs that your family might qualify for. In some cases, you get Medicaid through your parents’ plan. Or in other cases, you may be eligible for health insurance directly through CHIP. [Sources: Medicaid; CHIP.]

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Ask your parents NOW if you’re covered under their plan

EMPLOYER PLANS

Your parents can cover you until you turn 26

OBAMACARE/MARKETPLACE PLANS

Your parents can cover you until you turn 26

MEDICAID/CHIP PLANS

Your parents’ Medicaid can cover you until you turn 19, or (if you live at home) until 21; or via CHIP, you can be directly covered until you turn 19

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Once you are in 11th or 12th grade, it’s a good time to check in with your parents to find out how long you will continue to be covered by their health insurance.

That’s because there are different rules for how long you can be covered based on what type of health insurance plan your family has.

[Click twice to reveal “Employer Plans" and “Obamacare/Marketplace Plans” details.]

For example, if you’re covered by your parents employer plan or Obamacare/the Marketplace, the rules say you can continued to be be covered until you turn 26 years old. [Source: Healthcare.gov .]

[Click to reveal “Medicaid/CHIP plans” details.]

The rules are different with Medicaid and CHIP.

If you get insurance through your parents’ Medicaid, they can cover you until you turn 19. If you continue to live at home after that, you continue to be covered until you turn 21 years old.

If you get insurance through CHIP, your coverage stops when you turn 19.

[Sources: For Medicaid qualifying Income levels, here; for Medicaid/CHIP general age eligibility (for children under 19), here; for Medicaid coverage for children 19 and 20 who live at home, here.]

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How will you get health insurance in the future, if you’re not covered by your parents?

COLLEGE

Students can purchase health insurance from school

OBAMACARE/MARKETPLACE

See NYStateofHealth.NY.gov or Healthcare.gov

MEDICAID

Available if you qualify based on income

WORK

Most people get health coverage from their job

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If you’re not covered by your parents’ health insurance plan after you graduate from high school, here are some options:

Purchase health insurance through your college. Colleges often offer health insurance to students, and it’s definitely an option to keep in mind if you’re no longer covered by your parents.

One note: Sometimes schools will enroll you in and charge you for their coverage without asking if you need it. So if you are still covered by your parents’ plan, make sure to let the college know so you aren’t charged for something you don’t need. [Source: Good explainer here.]

Medicaid. Medicaid will offer you coverage that is more limited than what you’d get from the other options, but it’s better than going without coverage. You need to qualify for it based on your income. [Source: Medicaid.]

Work. If you are planning to go straight to a full-time job after high school, it’s worth finding an employer that offers health insurance. If you have a part-time job while in school or in a program, some companies offer health insurance for part-time workers. 60% of working adults get health insurance from their job. [Source.]

Obamacare/the Marketplace. You can purchase a health insurance policy on the marketplace on your own. You can find options from healthcare.gov or, for New York specifically, from NYStateofHealth.NY.gov.

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One thing to ask at a job interview: Do you offer health insurance?

GETTING HEALTH INSURANCE FROM WORK

It is often a very valuable benefit
It also saves you money: People pay around $111/month if they get health insurance from a job, versus $456/month if they don’t (and have to buy it themselves)

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OTHER TYPES OF INSURANCE YOU MIGHT NEED ONE DAY

RENTERS INSURANCE

Covers your possessions for fire, theft, etc.
Cost: $167 a year on average in NYC
If you own a home one day, you’ll need homeowners insurance

CAR INSURANCE

Covers damages to property and people hurt in an accident; NYS requires it
Cost: $163 per month on average in NYC, for the minimum amount required by NYS
Experts recommend you get more coverage than NYS requires (accidents are expensive!)

LIFE INSURANCE

Covers the people who rely on your income if you die
If you don’t have children or a spouse dependent on your income, you don’t need it

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So this lesson has been about health insurance, but there are some other types of insurance you should know about, since you’ll come across these in your adult life.

First is renters/home insurance.

If you rent an apartment (this includes living off campus during college), it’s smart to get this type of coverage. It covers the costs of all your possessions in your home -- including clothes, a laptop, and jewelry -- if they are ruined in a fire or stolen.

And one day, if you buy a home, you’ll need homeowners insurance, which can also cover the cost of rebuilding a home.

Auto or car insurance is required by law in New York State. [Source.] It protects damage to:

Property, such as cars (NYS requires a minimum of $10,000 coverage for this);

Medical costs for one person hurt in an accident (NYS requires you have a minimum of $25,000 coverage for this)

Medical costs for two or more people hurt in an accident (NYS requires you have a minimum of $50,000 coverage for this)

Note: because auto accidents can be costly -- the average car accident causes more than $26,000 of damage -- experts in the industry say to consider getting more coverage than what is required. [Source for expert opinion.]

The expert recommendation: $100,000 for property, $100,000 for one person in an accident, and $300,000 for two or more people in an accident. [Source for average accident cost.]

The typical cost for this recommended coverage: $350 per month. [Source.]

Last is life insurance.

This protects people who rely on you to financially support them, such as children or a spouse, if you die.

Until you have kids or family members relying on your income, skip it.

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FINAL REFLECTION

Based on what we discussed today…

What is your plan now for making sure you have health insurance once you graduate from high school?

placeholder

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For our final reflection: What is your plan now for making sure you have health insurance once you graduate from high school?? Take a moment to write down your thoughts on your worksheet. Consider everything we discussed today.

[Allow time for independent work, and either discuss as group (time permitting) or students can hand in before they leave.]

[Some points you may want to raise, or which students may bring up:

First, it’s important to talk to your parents now about your health insurance, to figure out how much longer you’ll be covered.

You might be covered on their employer health insurance, and they might be willing to cover you that way as long as they can (until you turn 26).

You might be covered on your parents’ Medicaid, and they might be willing to cover you that way as long as they can (until you turn 19, or (if you live at home) until 21).

You might be directly covered via CHIP, which you can stay on until you turn 19

Once you learn how you’re covered now, and how long you’ll continue to be covered that way, you’ll know at what age you’ll need to get your own health insurance. Your options are through your college, through work, through enrolling in Medicaid yourself, or through Obamacare/the marketplace.

Often, getting healthcare through work is your least expensive and most valuable option. Strongly consider looking for a job that provides it to you as a benefit.]