Welcome to English as a Second Language podcast number 676, Selecting a Health Insurance Plan.
This is English as a Second Language podcast episode 676.
I'm your host, Dr Jeff McQuillan, coming to you from the Center for Educational Development in beautiful Los Angeles, California.
Download our learning guide at eslpod.com.
This episode is called Selecting a Health Insurance Plan.
Let's get started.
What's all this?
It's open enrollment at my company and I'm thinking of switching health plans.
I have an HMO right now and I'm thinking of switching to a PPO.
That way I can see doctors outside of my current network and still be covered.
I'm so glad I don't have to worry about things like that.
I'm still a dependent on my mother's plan, at least for another year.
Lucky you.
Look at all of this literature.
How am I supposed to make heads or tails of this to compare one plan with another?
Wow, yeah, that's really confusing.
Tell me about it.
I want to know if these new plans have coverage for my pre-existing conditions and prescription drugs and, if not, what the out-of-pocket costs would be.
Don't look at me.
And how am I supposed to figure out what my copay and deductible would be?
You're on your own on this one.
It's all Greek to me.
Mikael begins by saying to Carol, What's all this?
What is all of this paper or what is all of the things that he sees in front of him?
Carol says it's open enrollment at my company and I'm thinking of switching health plans.
In the United States, as many of you know, most people get their health insurance from a private company.
Insurance is money you pay to a company in case, in this case, you are sick.
They will help pay your doctor bills.
They will pay for your doctor and the hospital or at least part of it.
So a health plan, a health insurance plan, is the agreement you have with the insurance company that allows you to pay them money and then they will pay for your medical bills if and when you have them.
The phrase open enrollment is a period of time once a year when employees of a company can choose a different health insurance plan.
They can choose sometimes a different company.
Now every company and every government organization offers different health plans.
Different companies.
Some companies, like the university where I used to work, would give you a choice of three or four different companies and their plans.
The company will pay part of the insurance bill and you typically will pay part of it as well.
So open enrollment is usually one time during the year a month, perhaps six weeks when employees can switch to a different plan if they want to.
To switch means to change from one thing to another.
You stop doing one thing and you start doing another.
I switched my mobile phone, my cellular phone company from Verizon to AT&T.
Those are two phone companies in the United States.
I was using one and now I'm using the other.
So Carol says it's open enrollment at my company and I'm thinking of switching or changing health plans.
She says, I have an HMO right now, and I'm thinking of switching to a PPO.
There are two basic kinds of health insurance plans that most companies offer to their employees.
One is called an HMO, which stands for Health Maintenance Organization.
Maintenance usually means keeping something working.
We talk about maintenance on your car.
Well, this is maintenance on your body to maintain it, to keep it working.
Who get their health insurance from an HMO usually receive most of their medical care from a single doctor who is part of this organization.
In many cases the HMO has its own hospitals, its own clinics, and the insurance will pay for your bills if you use the hospitals and the doctors that are part of that organization, that HMO.
The other kind of health insurance plan is called a PPO, which stands for or means Preferred Provider Organization.
Something you prefer is something that you like, that you want.
A provider is someone or some organization that gives you something, that provides you with something.
A PPO is a plan where you can see really any doctor that belongs to the group of doctors that are part of the organization.
Usually you don't have to ask anyone's permission.
PPOs have a lot more flexibility.
You don't have to just go to this organization's clinic.
You can go to many different kinds of clinics, as long as they are somehow participating in the PPO plan.
Now, PPO plans are typically more expensive.
They cost more money.
And they often don't pay for as much as an HMO does.
It depends on your health plan.
Carol says, I have an HMO right now and I'm thinking of switching to a PPO.
That way I can see doctors outside of my current network and still be covered.
Network here means a large group of related people or related organizations, people and organizations that are connected in some way.
Network has a couple of different meanings in English, as does the word switch we used a few minutes ago.
Those can be found in our learning guide.
Mikhail says, I'm still a dependent on my mother's plan, at least for another year.
A dependent is someone who depends on or relies on another person for their financial support.
This is often a young person 18 19 20, 21 years old perhaps who often is still living with his or her parents or one of their parents, and the parents are paying their bills.
They're paying for their health insurance, their food and so forth.
That's what we call a dependent in legal terms.
You could also have a dependent who was old.
For example, you might have your mother or your father that you take care of now and you pay their bills.
They would be then your dependent.
Well, that's the case for Mikael.
He doesn't have to worry because he has his mother's health insurance plan.
Carroll says, lucky you, meaning you are very lucky.
You are very fortunate.
Look at all this literature.
Literature here just means printed information about something.
It doesn't mean Charles Dickens and William Shakespeare.
Not that kind of literature.
Literature here means any sort of printed information, such as a brochure, a chart, a description on a piece of paper that is from a company, talking about that company's particular product or service.
Carroll says, how am I supposed to make heads or tails of this?
To compare one plan with another, to make heads or tails of something is to be able to understand something that is very confusing, that is very complex, very difficult.
Mikhail says, wow, yeah, that's really confusing.
Often the company will give you a piece of paper that will have all of the plans on it, a chart, and then all of the different benefits or things that the plan will pay for or cover.
It's often quite confusing.
Carol says, tell me about it, meaning, yes, I know it's confusing.
You don't have to tell me about it.
That's an odd expression.
When someone says, tell me about it, they mean I already know.
It's the opposite, really, of what they're saying.
Carol goes on and says I want to know if these plans have coverage for my pre-existing conditions and prescription drugs.
Coverage means that they will pay for something.
A pre-existing condition is a medical or health problem that you had before you signed up for the plan.
So if I have, for example, a problem with my heart when I sign up for a new health plan, I have to tell them I have a problem with my heart.
That's a pre-existing condition.
It exists before I become a member of the plan.
Prescription drugs are medicines that you must get a doctor's permission to purchase.
They cannot be bought and used unless a doctor says you can do that.
Often they'll give you a little piece of paper, which is also called sometimes the prescription.
But a prescription drug is a drug that a doctor has to give you authorization or permission to buy.
Carol says if not, if this new plan doesn't cover my pre-existing conditions and prescription drugs, what are the out-of-pocket costs?
Out-of-pocket P-O-C-K-E-T is the part of your medical expenses that you have to pay for that the company will not pay for.
A company may pay for the first $1,000 for each day in the hospital.
And if the hospital charges you $2,000, your out-of-pocket expense is $1,000 a day.
Your pockets, you probably know, are those little bags in your pants, if you will, where you can put things like your keys and your iPod.
Mikhail says, don't look at me.
This expression don't look at me is used to show that you do not want to be asked anything about this topic, often because you don't know anything about it or because you don't want to get involved.
Don't look at me.
I'm not an expert on health plans.
That's really what Mikhail is saying here.
Carol says and how am I supposed to figure out, to understand, what my copay and deductible would be?
Your copay C-O-P-A-Y is the amount or the percentage that you have to pay each time you go to the doctor.
It's a kind of out-of-pocket expense.
When I go to the doctor, I have to pay $50 every time I see the doctor.
And the health insurance company pays the rest of the doctor's bill for my visit.
But every time I go, I have to pay that $50.
That's a copay.
Co- means with, in this case, with someone else or with some other organization.
I pay part.
The health insurance company pays part.
A deductible is also an out-of-pocket expense.
It's the amount of money you have to pay before the company will start helping you with your medical bills.
Many companies have prescription drug deductibles.
So, for example, the first $250 I spend each year on prescription drugs, I have to pay for.
After I reach the limit of my deductible.
After I pay that 250, then the insurance company will start to help me pay for my prescription drugs, in this case.
Mikhail says, you're on your own on this one.
To be on your own means you have to do something alone, without receiving any other help.
Mikael says This phrase is used to show that you don't understand anything, usually because it's very complex or very unfamiliar.
Greek here refers to the Greek language.
Why do we say it's all Greek to me rather than it's all Romanian to me or Arabic to me?
If we believe Wikipedia...
The expression actually comes from a Latin expression, which means it's Greek.
It therefore cannot be read.
This was a phrase apparently used by a lot of the monks, male members of a special Christian community, who in the Middle Ages were copying manuscripts, copying old Greek books by hand, and Many of them did not know Greek and therefore they weren't able to copy certain things.
Ancient Greek as a language was not as well known to these scribes.
We call them these people who used to copy manuscripts, copy books by hand, way back in the Middle Ages, after the fall of the Roman Empire in Europe.
Now let's listen to the dialogue, this time at a normal speed.
What's all this?
It's open enrollment in my company and I'm thinking of switching health plans.
I have an HMO right now and I'm thinking of switching to a PPO.
That way, I can see doctors outside of my current network and still be covered.
I'm so glad I don't have to worry about things like that.
I'm still a dependent on my mother's plan, at least for another year.
Lucky you.
Look at all of this literature.
How am I supposed to make heads or tails of this to compare one plan with another?
Wow, yeah, that's really confusing.
Tell me about it.
I want to know if these new plans have coverage for my pre-existing conditions and prescription drugs and, if not, what the out-of-pocket costs would be.
Don't look at me.
And how am I supposed to figure out what my co-pay and deductible would be?
You're on your own on this one.
It's all Greek to me.
The person who helps us make heads or tails of the English language is our wonderful script writer, Dr Lucy Say.
From Los Angeles, California, I'm Jeff McQuillan.
Thank you for listening.
Come back and listen to us again on ESL Podcast.
English as a Second Language podcast is written and produced by Dr Lucy Say, hosted by Dr Jeff McQuillan.
Copyright 2011 by the Center for Educational Development.
