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Speaker 1: At some point in life. Everyone needs to see a doctor,

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Speaker 1: and arguably many of us should be going way more

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Speaker 1: frequently than we actually do. But seeing a doctor here

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Speaker 1: in the United States can sometimes result in an expensive bill,

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Speaker 1: especially if you're uninsured, and sometimes even if you are insured,

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Speaker 1: maybe your appointment, or your treatment or your provider wasn't

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Speaker 1: included as part of your medical coverage. According to research

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Speaker 1: led by the Johns Hopkins Bloomberg School of Public Health,

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Speaker 1: the average cost of an appointment with a primary care

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Speaker 1: doctor for an uninsured patient in twenty fifteen was one

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Speaker 1: hundred and sixty dollars, and from the same case study,

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Speaker 1: only seventy nine percent of the uninsured patients were even

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Speaker 1: offered an appointment. In May of twenty twenty three, Forbes

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Speaker 1: published in an article comparing the cost of health insurance

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Speaker 1: on the ACA marketplace. They found that the monthly cost

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Speaker 1: for an adult twenty one years of age ranged from

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Speaker 1: three hundred and thirty to four hundred and four dollars

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Speaker 1: depending on the plan, and for a twenty seven year

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Speaker 1: old adult that range increase, with the lowest plan costing

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Speaker 1: four hundred and five dollars to the highest level costing

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Speaker 1: about four hundred and twenty three a month, and these

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Speaker 1: rates are based on single adults without dependence. Now you

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Speaker 1: may be trying to do some math to sort out

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Speaker 1: if you can save some money by going without insurance.

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Speaker 1: I mean, how often do you see your primary care doctor?

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Speaker 1: After all? Aside from the fact that you should be

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Speaker 1: going to see your primary care doctor ideally every year

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Speaker 1: for a regular physical, there are other doctors you should

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Speaker 1: also be going to see regularly. I mean, there's your dermatologists.

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Speaker 1: You should be going every year for a skin check.

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Speaker 1: And if you're someone who visits the guynecologists, that's another

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Speaker 1: exam that should be done annually. And those types of

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Speaker 1: doctor's visits typically cost more than a primary care doctor.

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Speaker 2: But perhaps the.

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Speaker 1: Biggest reason why we need insurance is for those unexpected

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Speaker 1: health issues that can arise. What if you're in a

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Speaker 1: car accident or you find yourself really sick with a

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Speaker 1: more long term diagnosis. That's when medical costs can become

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Speaker 1: insurmountable and insurance can make a huge difference. The end

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Speaker 1: of October is typically the time of year when open

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Speaker 1: enrollment begins for a lot of health insurance plans. This

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Speaker 1: is the window of time when you can change or

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Speaker 1: enroll in a health insurance plan, and once that window closes,

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Speaker 1: you have to wait again to enroll or make any

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Speaker 1: changes until next year. But with so many options and

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Speaker 1: plans ranging significantly in cost, how do you know which

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Speaker 1: one is the best one for your needs and for

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Speaker 1: your budget? And what on earth is a ppo versus

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Speaker 1: an EPO? Start taking notes because this.

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Speaker 3: Is grown up stuff.

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Speaker 1: Hello, and welcome to another episode of grown Up Stuff

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Speaker 1: How to Adult, the podcast where we figure out things

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Speaker 1: like what's a premium and what's included in a deductible?

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Speaker 1: All in the name of adulthood. I'm Mollie and I'm

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Speaker 1: joined by my co host, Matt Stillo, and we hope

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Speaker 1: that you are healthy and well as you are listening

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Speaker 1: to this podcast because we're going to dig into health

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Speaker 1: insurance on this episode. What is it? Why do we

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Speaker 1: need it? Why does it seem to be written in

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Speaker 1: another language that relies so heavily on acronyms. But to

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Speaker 1: start us all off, Matt, what was your earliest experience

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Speaker 1: with health insurance and what has it been like in

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Speaker 1: your young life? Has it been good?

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Speaker 3: Yeah, bad?

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Speaker 2: Confusing?

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Speaker 4: Well, thank you for calling me young on this podcast.

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Speaker 4: Because this year and I don't know how I feel

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Speaker 4: about very young, but.

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Speaker 1: We all feel some sort of way about that age,

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Speaker 1: about all the ages. So you're doing great, Matt, You're

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Speaker 1: doing great.

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Speaker 4: So for everyone out there who's like, you know, unemployed, underemployed,

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Speaker 4: you were in the right place because I was actually

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Speaker 4: on my parents' healthcare up until the last possible second.

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Speaker 4: I was like about to turn twenty seven, right before

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Speaker 4: like the enrollment period for the new year, and I

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Speaker 4: got this job, my first like full job with like

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Speaker 4: four oh one K and salary and healthcare, and I

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Speaker 4: was like I couldn't believe it. I like, I got

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Speaker 4: through that open enrollment and I was like, wow, under

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Speaker 4: the freaking wire because I was so worried about what's

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Speaker 4: gonna happen now, you know, that wave of relief quickly

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Speaker 4: subsided as I was reading through the healthcare plans because

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Speaker 4: what the hell? Yeah, all this lingo, like how is

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Speaker 4: a child right? Because twenty six is a child supposed

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Speaker 4: to figure that stuff out? Even my parents couldn't help

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Speaker 4: me because it's gotten so confusing in the last few years.

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Speaker 4: So after it was all said and done, I felt like,

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Speaker 4: did I make the right decision.

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Speaker 3: I have no idea.

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Speaker 4: Every subsequent year, I was trying to like do right,

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Speaker 4: Like I'm gonna get it this time. Yeah, I'm gonna

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Speaker 4: get it this time.

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Speaker 1: Yeah.

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Speaker 3: And I don't think even.

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Speaker 4: To this day, I've ever really fully figured it out.

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Speaker 4: But I just want everyone to know out there that, like,

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Speaker 4: if you are confused by this, it is okay, We're

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Speaker 4: going to figure it all out together. But Molly, yeah,

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Speaker 4: I feel like you probably felt the exact same way.

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Speaker 1: Oh. I mean, I'll hit submit and I'll go back

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Speaker 1: and review before the window of open enrollment closes, ultimately

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Speaker 1: decide I've made the right decision. But once that period ends,

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Speaker 1: I'm like, Nope, I've made the wrong decision. I know it.

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Speaker 1: I've made the wrong decision. But let's get to our

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Speaker 1: conversation with our guests, because I do think she's going

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Speaker 1: to be able to clarify a lot of this for us.

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Speaker 4: Today we are joined by the one and only Julie Robner.

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Speaker 4: Julie is the Chief Washington correspondent and host of What

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Speaker 4: the Health, a weekly health policy news podcast from KFF

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Speaker 4: Health News.

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Speaker 1: KFF Health News is a national newsroom that focuses on

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Speaker 1: health issues and was founded by the Kaiser Family Foundation,

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Speaker 1: which is now more commonly referred to as KFF. Julie

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Speaker 1: joined the KFF Health News team after sixteen years as

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Speaker 1: a health policy correspondent for NPR, where she helped lead

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Speaker 1: the network's coverage of the Affordable Care Act.

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Speaker 4: Julie is also the author of the book Healthcare, Politics

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Speaker 4: and Policy, a Disease, and the recipient of the National

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Speaker 4: Press Foundation's Everett McKinley Dirkson Award for Distinguished Reporting of Congress. Well,

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Speaker 4: Julia Rovner, thank you so much for joining us on

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Speaker 4: this episode of grown Up Stuff?

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Speaker 3: How do adult?

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Speaker 4: And at this podcast, we'd like to really like ask

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Speaker 4: the most dumb question straight.

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Speaker 1: Out of the gate, because you're kind of anything.

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Speaker 4: Exactly, and that really dumb question is what exactly is

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Speaker 4: health insurance and why is it so important to have,

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Speaker 4: especially in the United States.

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Speaker 2: Well, health insurance is supposed to prevent you from going

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Speaker 2: broke if something bad happens to you. A lot of

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Speaker 2: young people don't think they need health insurance because, after all,

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Speaker 2: they're less likely to get sick. But you know, even

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Speaker 2: a twenty five year old can get hit by a

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Speaker 2: bus or run into a tree. If you go skiing,

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Speaker 2: things can happen. Unfortunately, young people get very serious diseases.

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Speaker 2: And if you don't have health insurance, our healthcare system

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Speaker 2: is really, really expensive. You do not want to get

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Speaker 2: caught up in it if you don't have some kind

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Speaker 2: of insurance.

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Speaker 1: You know, that's a really good point. Young people are

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Speaker 1: not exempt from getting cancer, unfortunately, and sadly, I've had

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Speaker 1: a handful of friends in their late twenties and early

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Speaker 1: thirties who have been diagnosed with cancer. And even things

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Speaker 1: like a broken bone can be really expensive without insurance.

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Speaker 1: But I myself have been in situations where I've either

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Speaker 1: been in between jobs or freelancing. So what are the

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Speaker 1: best options to get health insurance if we can't get

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Speaker 1: it through an employer.

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Speaker 2: Well, congratulations, we now all have options which we didn't

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Speaker 2: when I was a young freelancer. That is exactly what

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Speaker 2: the Affordable Care Act was aimed at. It was aimed

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Speaker 2: at people that don't get their health insurance on the

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Speaker 2: job provided by an employer. So basically, if you're working

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Speaker 2: for yourself, you can buy insurance and it's pretty good

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Speaker 2: insurance on the healthcare exchange. And if you don't earn

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Speaker 2: a lot of money, you'll get a subsidy, in some

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Speaker 2: cases a really big subsidy, So not only will you

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Speaker 2: not have to pay very high premiums, and particularly if

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Speaker 2: you're younger, you might not even have to pay very

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Speaker 2: much if you have to go and get care. You

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Speaker 2: can get savings on your your co payments and deductible.

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Speaker 2: So there are a lot of ways that the Affordable

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Speaker 2: Care Act is aimed at getting people insured who were

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Speaker 2: not previously eligible, either for Medicare or Medicaid or an

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Speaker 2: employer to ensure them. So that's the good news. The

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Speaker 2: other way, of course, you can get insured or stay

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Speaker 2: insured if you've had a job in your between jobs

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Speaker 2: is there something called cobra which allows you to continue

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Speaker 2: your employer insurance until you get another job, or another

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Speaker 2: way to get insurance. But if you had insurance and

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Speaker 2: you lose it for pretty much any reason, you can

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Speaker 2: sign up under the Affordable Care Act at any time

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Speaker 2: of the year. You get your own personal open enrollment period.

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Speaker 4: Just so that I'm clear on this, was there no

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Speaker 4: way to directly go to a health insurance company before

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Speaker 4: the ACA otherwise known as Obamacare, was enacted.

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Speaker 2: There were lots of ways to go to a health

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Speaker 2: insurance company before the Affordable CARECT. The problem is they

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Speaker 2: might not have sold you insurance because they didn't always

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Speaker 2: have to. In states where they said you have to

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Speaker 2: take everybody even if they're sick, the insurance said, okay, bye,

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Speaker 2: we're just not going to sell in this state. So

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Speaker 2: there were a lot of people who wanted to get

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Speaker 2: insurance who couldn't. If you were really healthy, they were

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Speaker 2: likely to sell you. Insurance could have been, depending on

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Speaker 2: where you live, pretty cheap or pretty expensive. But sometimes

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Speaker 2: when it was really cheap, it didn't cover very much.

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Speaker 2: There were health insurance policies that would only cover up

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Speaker 2: to the first five hundred dollars worth of care that

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Speaker 2: barely gets you in the door at a hospital and

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Speaker 2: even a doctor's office in some case. So there was

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Speaker 2: a lot of bad health insurance and a lot of

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Speaker 2: health insurance it wasn't really insurance. And one of the

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Speaker 2: things that the Affordable Care Act did, and it was controversial,

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Speaker 2: was to say that these are going to be the

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Speaker 2: standard benefits that every accredited health insurance policy has to offered.

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Speaker 2: That of course made a lot of health insurance a

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Speaker 2: lot more expensive because hey, now it had cover actual stuff.

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Speaker 2: But I think a lot of people who didn't need

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Speaker 2: their health insurance very often didn't realize how little their

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Speaker 2: health insurance covered.

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Speaker 4: Actually puts it in a great perspective, like you know

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Speaker 4: how historic the Affordable Care Act was. I was before

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Speaker 4: I had had my first job and have my first

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Speaker 4: health insurance plan, so I did not really realize how

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Speaker 4: big of a deal.

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Speaker 3: That is.

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Speaker 4: The one other thing that I wanted to ask you

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Speaker 4: about and maybe why it was included in the Affordable

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Speaker 4: Care Act, which is the dependents you know, children who

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Speaker 4: are on their parents' plan, they can stay on those

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Speaker 4: plans until you're twenty six.

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Speaker 3: Why exactly was that included in the ACA?

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Speaker 2: This was a huge, huge deal until then Moost kids

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Speaker 2: got kicked off their parents' plans when they turned eighteen.

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Speaker 2: If they went to college, they would buy student health plans.

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Speaker 2: Then they would graduate and they would have no insurance.

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Speaker 2: And it was a big problem and also was a

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Speaker 2: deterrent to do things like go join the Peace Corps,

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Speaker 2: you know, become a volunteer somewhere, take an internship, or

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Speaker 2: take any kind of job that didn't offer health insurance.

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Speaker 2: Because it's so dangerous to be uninsured. These days. So

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Speaker 2: basically what they said was, we're going to require employee

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Speaker 2: to allow kids to stay on their parents' plans until

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Speaker 2: they're twenty six. And the idea is that by the

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Speaker 2: time somebody is twenty six, they should be grown up

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Speaker 2: enough to find a way to have health insurance, either

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Speaker 2: be established as a freelancer or have a job that

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Speaker 2: provides insurance. But basically want to be able to get

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Speaker 2: kids through school and through higher learning and still keep

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Speaker 2: them insured. And also a lot of young people, as

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Speaker 2: I mentioned, at some point, don't think they need health

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Speaker 2: insurance and don't buy it, and this is just an

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Speaker 2: easier way for parents to make sure that their kids

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Speaker 2: are insured even as they are launching their own careers.

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Speaker 2: It was an extremely popular benefit. It was one of

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Speaker 2: the few benefits in the ACA that was completely bipartisanly popular.

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Speaker 2: Both sides wanted it, and it's obviously a fairly highly

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Speaker 2: used benefit.

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Speaker 1: The Affordable Care Act or ACA or Obamacare is a

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Speaker 1: comprehensive healthcare reform law that was enacted in March twenty ten.

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Speaker 1: According to the US Department of Health and Human Services,

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Speaker 1: the law had three primary goals. One, make affordable health

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Speaker 1: insurance available to more people, to expand the Medicaid program

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Speaker 1: to cover all adults with income below one hundred and

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Speaker 1: thirty eight percent of the federal poverty level, and three

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Speaker 1: support innovative medical care delivery methods designed to lower costs

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Speaker 1: of healthcare generally. As Julie mentioned, one way they achieved

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Speaker 1: this was by increasing the age of health insurance dependence

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Speaker 1: to twenty six. Now, I personally didn't have the slightest

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Speaker 1: idea how to properly choose a health insurance plan when

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Speaker 1: I did turn twenty six, and I was often asking

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Speaker 1: coworkers what they chose for guidance. And that's because when

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Speaker 1: I was given these options, I felt like I needed

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Speaker 1: a translator for all of the different terms.

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Speaker 4: Before we get into anything too specific, I think there's

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Speaker 4: a couple of terms that we should really like talk

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Speaker 4: about what they mean exactly. So first, would you mind

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Speaker 4: telling us what a premium is.

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Speaker 2: A premium is the amount you pay basically to have insurance.

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Speaker 2: So it will usually be a monthly fee, and that's

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Speaker 2: what makes you a policy holder, is paying the premium.

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Speaker 2: Usually if it's employer provided insurance, the employer will pay

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Speaker 2: at least some, possibly most in a few cases. All

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Speaker 2: of the premium, but generally there is someone pays the

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Speaker 2: premium for you to have insurance.

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Speaker 4: Awesome, Okay, I'm just going to rattle through the So

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Speaker 4: deductible what is a deductible.

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Speaker 2: Deductible is how much you pay out of pocket before

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Speaker 2: your insurance starts paying Deductibles can most are in this

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Speaker 2: sort of couple of hundred to several hundred dollars range,

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Speaker 2: which in theory is what people can afford. It depends,

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Speaker 2: you know, if you have a family, sometimes it can

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Speaker 2: be you know, five hundred dollars for each member of

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Speaker 2: the family. That can turn into a lot of money

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Speaker 2: pretty quick. But the general rule of thumb is the

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Speaker 2: higher your premium, the lower you're deductible. So if you

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Speaker 2: don't think you're going to use a lot of health insurance,

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Speaker 2: you might want to get something with a lower premium

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Speaker 2: but a higher deductible, and vice versa. If you think

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Speaker 2: you will use insurance, you might want to get a

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Speaker 2: higher premium with a lower deductible so your insurance kicks

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Speaker 2: in faster.

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Speaker 3: Awesome. And then what about like copay and co insurance.

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Speaker 2: Yeah, those are two slightly different things. But the idea

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Speaker 2: is that once you reach the place where your insurance

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Speaker 2: starts paying for things. It's shared. Insurance rarely pays one

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Speaker 2: hundred percent of anything, So either they will charge you

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Speaker 2: a co pay. They will say, if you go to

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Speaker 2: the pharmacy and you get one of these, you know,

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Speaker 2: four hundred common drugs, you will have a copay of

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Speaker 2: ten dollars, and if you get a slightly more expended drug,

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Speaker 2: you'll have a copay of twenty dollars. Co insurance is

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Speaker 2: when they say, if you go to the doctor or

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Speaker 2: the hospital, we're going to pay eighty percent or ninety percent,

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Speaker 2: and you're going to pay the other ten percent. Co

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Speaker 2: insurance can turn into a lot of money these days

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Speaker 2: when health care is so expensive. You know, people think, oh,

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Speaker 2: it's I have a five percent co insurance if you

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Speaker 2: go to the hospital. Five percent can very quickly become

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Speaker 2: many thousands of dollars.

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Speaker 4: Truly, it's insane. And so I have a deductible and

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Speaker 4: I hit that. But then why is there an out

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Speaker 4: of pocket maximum?

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Speaker 5: Great question, That's a very good question, because, as I

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Speaker 5: just said, your co insurance can turn into a lot

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Speaker 5: of money very quickly, and that's why plans are required

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Speaker 5: to have an out of pocket maximum, so you don't

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Speaker 5: once you hit a certain number, usually in the near

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Speaker 5: ten thousand dollars range, you don't have to pay anything

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Speaker 5: more for the rest of the year.

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Speaker 2: Then the calendar will reset and you'll have to start again.

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Speaker 2: But it's generally, yeah, even if you have health insurance,

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Speaker 2: you can end up on the hook for a lot

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Speaker 2: of money. That's why they have things like flexible spending

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Speaker 2: accounts and health savings accounts. Healthcare these days is really

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Speaker 2: expensive in the United States, even with insurance.

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Speaker 1: Yeah, So to clarify just that, I understand this. So

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Speaker 1: your deductible, once you meet that, then they'll cover a

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Speaker 1: certain percentage of certain things right.

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Speaker 2: Right up to your out of pocket maximum.

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Speaker 1: It's like basically a video game. You're like, you get

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Speaker 1: to the first boss, and you get to the second boss,

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Speaker 1: and you get to the second bus. You win and

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Speaker 1: you get all these new things and you can do anything.

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Speaker 1: So after you hit that out of pocket though, then

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Speaker 1: they have to cover everything. Right, Is that correct?

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Speaker 2: It's usually right? There are things then there we'll say, well,

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Speaker 2: you're not in networks, so we're not going to cover

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Speaker 2: all of it. There are exceptions to that. You know,

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Speaker 2: if it's not covered by the plan, then they can

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Speaker 2: make you pay it. CAFF Health News and NPR and

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Speaker 2: CBS have been doing something we call the Bill of

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Speaker 2: the Months for a couple of years now, where people

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Speaker 2: send us their medical bills that they just can't handle,

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Speaker 2: and we try to sort out what's going on. And

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Speaker 2: there are cases where people have been you know, they've

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Speaker 2: gone way over there out of pocket maximum, but they've

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Speaker 2: been billed anyway. Sometimes they're actually liable for those bills.

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Speaker 2: Sometimes they're not. Do you want the out of pocket

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Speaker 2: maximum for this year?

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Speaker 1: Yes?

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Speaker 2: Please? What is it for the twenty twenty four plan

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Speaker 2: your guests? The out of pocket maximum for a marketplace

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Speaker 2: plan can't be more than ninety four hundred and fifty

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Speaker 2: dollars for an ind of one, eighteen nine hundred dollars

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Speaker 2: for a family.

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Speaker 1: It's a lot of money.

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Speaker 2: That's not just a lot of money, And it says

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Speaker 2: the things that they don't cover. It doesn't you're out

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Speaker 2: of pocket. Doesn't cover premiums, it doesn't. It says it

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Speaker 2: doesn't cover anything you spend for services your plan doesn't cover,

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Speaker 2: doesn't cover out of network care and services, doesn't cover

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Speaker 2: costs above the allowed amount for a service a provider

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Speaker 2: may charge.

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Speaker 1: So I was curious about what goes towards my deductible

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Speaker 1: because sometimes I think, I'm like, whoa, I've spent I

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Speaker 1: must have hit my deductible at this point, like I've

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Speaker 1: spent so much money. But you're telling me if I've

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Speaker 1: paid out of pocket for something my insurance doesn't cover

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Speaker 1: to begin with, then that doesn't count towards my deductible.

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Speaker 2: No, And that's it's really important to know what does

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Speaker 2: and doesn't count towards your deductible. In some plans, out

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Speaker 2: of network care won't count towards your deductible, or you'll

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Speaker 2: have a separate out of network deductible and in network deductible.

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Speaker 2: Then usually that out of network deductible will be higher.

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Speaker 2: So it's not just anything you spend on medical care,

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Speaker 2: it's anything that you spend on medical care that would

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Speaker 2: be covered after you hit your deductible.

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Speaker 1: Son of a bitch cheer leading. Oh and for one

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Speaker 1: more cherry. On top of this depressing deductible. Sunday, we

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Speaker 1: did some additional digging and discovered most plans do not

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Speaker 1: count your copays towards meeting your deductible.

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Speaker 4: So what exactly is a healthcare network and like, why

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Speaker 4: are some doctors in it and then others not.

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Speaker 2: Generally, a healthcare network is a group of providers, so doctors, labs, hospitals,

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Speaker 2: urgent care centers that have signed contracts with the insurer.

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Speaker 2: And generally the deal is the insurer says, we will

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Speaker 2: send you our patients, so you will get more patients,

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Speaker 2: and in exchange, you will give us a better price.

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Speaker 2: So those are that's how you stay in network. And

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Speaker 2: because the insurer knows what they're going to pay you,

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Speaker 2: the patient will only have to pay a limited amount.

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Speaker 2: Usually known it used to be sort of flat dollar

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Speaker 2: copayments ten or fifteen or twenty dollars. More commonly these

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Speaker 2: days it's co insurance, so you'd have to pay ten

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Speaker 2: percent or twenty percent, which can turn into a lot

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Speaker 2: of money. But generally, staying within your network of doctors, hospitals,

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Speaker 2: and other healthcare facilities is going to be a lot

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Speaker 2: cheaper than going outside the network, where the insurer doesn't

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Speaker 2: have a deal to get a better rate from the

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Speaker 2: provider and may have to pay more even if you're

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Speaker 2: gonna pay more too.

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Speaker 1: And what's the best way for us to determine who's

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Speaker 1: included and who isn't.

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Speaker 2: Oh, such a good question, that should be so easy.

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Speaker 2: There are provider directories where you can see who's in

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Speaker 2: the plan and who isn't, except it turns out the

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Speaker 2: provider directories are often wrong or incomplete. Unfortunately, this is

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Speaker 2: something that's been going on for decades, and now that

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00:19:53,520 --> 00:19:56,399
Speaker 2: it's ever more important to know who's in your network

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Speaker 2: and who isn't, it's still really hard to find out,

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Speaker 2: so you have to call each provider until this year.

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Speaker 2: Last year there was also this problem about something called

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Speaker 2: surprise bills, where you go to an in network hospital.

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Speaker 2: You know what's in your network, but you get treated

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Speaker 2: by a doctor who's not in the network, and you

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Speaker 2: don't have a choice. It might be the pathologist or

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Speaker 2: the anesthesiologist. You know, you schedule surgery and you know

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Speaker 2: you're having surgery with this surgeon, and sometimes you'll call ahead,

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Speaker 2: is the anti caesiologist in my network? And it's like, well,

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Speaker 2: we don't really know who your anesthesiologist is going to

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Speaker 2: be that day, so you have no idea, and then

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Speaker 2: you would get these huge bills from emergency room doctors

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Speaker 2: or antithesiologist or doctors that you didn't choose. Congress finally

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Speaker 2: made that illegal, but only very recently.

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Speaker 3: Oh my gosh.

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Speaker 2: You know, the best way to find out if a

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Speaker 2: provider is a network is yes, I know, I know that.

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Speaker 2: You know, like people under forty eight talking to people

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Speaker 2: on the phone, but this is a case where you

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Speaker 2: might want to talk to people on the show. They

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Speaker 2: don't always know either, but it's worth asking. I mean,

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Speaker 2: I still go to providers that are you know, I'm

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Speaker 2: pretty sure a network, but you know, you keep asking,

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Speaker 2: are you really in my network? Am I really not

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Speaker 2: going to get a bill for a thousand dollars a year?

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Speaker 1: Well?

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Speaker 4: I glad that's not just me because I feel like

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Speaker 4: I have to do that every single time too, And

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Speaker 4: I'm like, is this really how it works? Like we

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Speaker 4: just have to do this all the time. Yeah, apparently

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Speaker 4: it is.

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Speaker 2: Our health system is not the most efficient or user

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Speaker 2: friendly or inexpensive. It's it's a lot of things that

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Speaker 2: are not very good. I think there's a lot of

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Speaker 2: disagreement on how to fix the healthcare system, but there's

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Speaker 2: a whole lot of agreement that it is not working

440
00:21:29,320 --> 00:21:29,920
Speaker 2: well right now.

441
00:21:30,359 --> 00:21:33,359
Speaker 1: It is complicated, But this is why these conversations are

442
00:21:33,400 --> 00:21:36,600
Speaker 1: so important so that we could be equipped with all

443
00:21:36,640 --> 00:21:38,720
Speaker 1: of the knowledge and the tools and the resources to

444
00:21:38,840 --> 00:21:40,040
Speaker 1: make the best decisions.

445
00:21:40,440 --> 00:21:43,720
Speaker 2: This is a really important part of adulting. So I mean, yeah,

446
00:21:43,800 --> 00:21:47,240
Speaker 2: health insurance saving for retirement thinks that we're a lot

447
00:21:47,320 --> 00:21:49,880
Speaker 2: cheaper when I was a young adult, are a lot

448
00:21:49,920 --> 00:21:53,120
Speaker 2: more expensive now and you're a lot more on your own.

449
00:21:56,280 --> 00:21:58,399
Speaker 1: We'll be right back with more grown up stuff how

450
00:21:58,400 --> 00:22:07,679
Speaker 1: to adult. After a quick break, and we're back with

451
00:22:07,800 --> 00:22:14,600
Speaker 1: more grown up stuff how to adults. Let's go into

452
00:22:15,240 --> 00:22:19,560
Speaker 1: you know, the major health insurance plan options. For those

453
00:22:19,920 --> 00:22:23,719
Speaker 1: of us who you know are employed, we know there's HMO,

454
00:22:24,040 --> 00:22:30,120
Speaker 1: p PO, E PO POS, hgh HP, which we're gonna

455
00:22:30,119 --> 00:22:33,159
Speaker 1: so yeah, so let's start with the top. HMO. What

456
00:22:33,200 --> 00:22:33,800
Speaker 1: does it stand for?

457
00:22:34,320 --> 00:22:37,320
Speaker 2: So, an HMO stands for Health Maintenance Organization. It was

458
00:22:37,400 --> 00:22:42,680
Speaker 2: traditionally the most structured and limited way to get health insurance.

459
00:22:42,720 --> 00:22:45,119
Speaker 2: And basically what the HMO says is we're going to

460
00:22:45,119 --> 00:22:47,480
Speaker 2: get a certain amount of money a month for each

461
00:22:47,520 --> 00:22:49,640
Speaker 2: patient and work that's going to cover all their care.

462
00:22:49,880 --> 00:22:52,320
Speaker 2: So in theory, you should never get a bill or

463
00:22:52,560 --> 00:22:54,960
Speaker 2: rarely get a bill if you're in an HMO and

464
00:22:55,240 --> 00:22:57,879
Speaker 2: you basically have to go to all of their providers.

465
00:22:58,119 --> 00:23:02,200
Speaker 2: Traditional HMO like Kaiser per Empty, has their own hospitals

466
00:23:02,200 --> 00:23:04,680
Speaker 2: in many states, they don't in the eastern part of

467
00:23:04,720 --> 00:23:06,719
Speaker 2: the country where they offer insurance, so they will have

468
00:23:07,040 --> 00:23:09,879
Speaker 2: deals with other hospitals. But generally you have to stay

469
00:23:09,920 --> 00:23:13,080
Speaker 2: within the network, so it's the most restrictive. It's the

470
00:23:13,119 --> 00:23:16,359
Speaker 2: hardest to go out and see other specialists or go

471
00:23:16,560 --> 00:23:20,600
Speaker 2: other places. And generally it has had traditionally the lowest

472
00:23:20,600 --> 00:23:23,600
Speaker 2: premiums because it's the most restrictive. And then as you

473
00:23:23,680 --> 00:23:26,520
Speaker 2: go further out, every time it gets easier for you

474
00:23:26,600 --> 00:23:29,720
Speaker 2: to go outside of the network and get care from

475
00:23:29,960 --> 00:23:32,960
Speaker 2: other places, your premium goes up because it's likely that

476
00:23:33,040 --> 00:23:35,200
Speaker 2: the cost of the insurer is going to go up.

477
00:23:35,520 --> 00:23:40,919
Speaker 2: So you're generally trading off restrictions in providers versus amount

478
00:23:41,000 --> 00:23:41,719
Speaker 2: of premium.

479
00:23:42,320 --> 00:23:46,480
Speaker 1: Interesting. So this then I feel like, and maybe I'm wrong,

480
00:23:46,480 --> 00:23:48,480
Speaker 1: but I feel like PPO and EPO kind of go

481
00:23:48,640 --> 00:23:49,880
Speaker 1: hand in hand, right.

482
00:23:50,440 --> 00:23:53,159
Speaker 2: They do, And an EPO is sort of a cross

483
00:23:53,240 --> 00:23:57,240
Speaker 2: between a POPPO is a preferred provider organization. I'm in

484
00:23:57,280 --> 00:23:59,720
Speaker 2: a preferred provider organization where I don't have to go

485
00:24:00,119 --> 00:24:02,240
Speaker 2: to the preferred providers, but if I do, it's a

486
00:24:02,240 --> 00:24:05,720
Speaker 2: whole lot cheaper. So you're encouraged to stay in the

487
00:24:05,760 --> 00:24:08,679
Speaker 2: network as opposed to being required to stay in the

488
00:24:08,720 --> 00:24:13,639
Speaker 2: network EPO, which I think is exclusive provider organization. The

489
00:24:13,720 --> 00:24:16,120
Speaker 2: acronyms don't mean as much as they used to, which

490
00:24:16,160 --> 00:24:18,720
Speaker 2: is what gets a little bit frustrating to people. And

491
00:24:18,800 --> 00:24:21,159
Speaker 2: of course, the other thing that it's really important to

492
00:24:21,280 --> 00:24:23,280
Speaker 2: trade off, and I guess we'll get to this, is

493
00:24:23,320 --> 00:24:26,080
Speaker 2: it your premium, you're deductible are going to be directly linked.

494
00:24:26,080 --> 00:24:28,800
Speaker 2: And that's really true in the Affordable Care Act plant

495
00:24:28,840 --> 00:24:32,119
Speaker 2: it's like the lower your premium, the higher you're deductible,

496
00:24:32,119 --> 00:24:33,600
Speaker 2: the most you're going to have to pay out of

497
00:24:33,680 --> 00:24:36,439
Speaker 2: pocket before the insurance kicks in, you know. And if

498
00:24:36,480 --> 00:24:39,040
Speaker 2: you pay a higher premium, you'll have a lower deductible.

499
00:24:39,119 --> 00:24:43,480
Speaker 2: So unfortunately, there is sometimes arithmetic involved. It's not higher math.

500
00:24:43,280 --> 00:24:46,280
Speaker 1: But it's math fair. As we always say, it never

501
00:24:46,359 --> 00:24:48,399
Speaker 1: hurts to do your homework or do the math for

502
00:24:48,440 --> 00:24:53,199
Speaker 1: that matter. Okay, now, pos I've seen this and it

503
00:24:53,240 --> 00:24:54,520
Speaker 1: does not mean piece of shit.

504
00:24:56,200 --> 00:24:58,639
Speaker 2: It means a point of service, and that's basically the

505
00:24:58,680 --> 00:25:01,880
Speaker 2: PPO plan where you can go out of network and

506
00:25:01,920 --> 00:25:05,560
Speaker 2: they will pay a certain share. So typically, if you

507
00:25:05,560 --> 00:25:08,040
Speaker 2: stay in network, you'll only have to have a copey.

508
00:25:08,080 --> 00:25:10,399
Speaker 2: I think my cope is fifteen dollars, which is pretty

509
00:25:10,440 --> 00:25:14,200
Speaker 2: good for you know providers in network. It's really good. Yeah,

510
00:25:14,240 --> 00:25:16,440
Speaker 2: it's very good. If I go out of network after

511
00:25:16,480 --> 00:25:19,760
Speaker 2: I've hit my deductible, they'll pay seventy percent and I'll

512
00:25:19,800 --> 00:25:21,080
Speaker 2: pay the other thirty percent.

513
00:25:21,720 --> 00:25:24,359
Speaker 1: Now, HDHP, I actually know at this dance or a

514
00:25:24,440 --> 00:25:27,639
Speaker 1: high deductible health plan right now, this is different.

515
00:25:28,200 --> 00:25:30,800
Speaker 2: It is, and it's confusing because there are a lot

516
00:25:30,800 --> 00:25:34,439
Speaker 2: of sort of regular health plans, particularly the bronze plants

517
00:25:34,440 --> 00:25:37,280
Speaker 2: in the affordable character, that have high deductibles. That it

518
00:25:37,480 --> 00:25:41,640
Speaker 2: used to be when they started these the early two thousands,

519
00:25:42,080 --> 00:25:45,760
Speaker 2: people's deductibles tended to be in the you know, one hundred,

520
00:25:45,800 --> 00:25:48,520
Speaker 2: two hundred, three hundred dollars range, which I know sounds

521
00:25:48,600 --> 00:25:53,040
Speaker 2: like quaint today. Right the HDHP plans, the idea was

522
00:25:53,119 --> 00:25:55,240
Speaker 2: you would have a deductible of one thousand dollars or

523
00:25:55,280 --> 00:25:59,080
Speaker 2: fifteen hundred dollars, which is pretty standard right now. But

524
00:25:59,400 --> 00:26:02,280
Speaker 2: the catch you weren't going to have to necessarily pay

525
00:26:02,280 --> 00:26:04,760
Speaker 2: that whole deductible because you were also going to have

526
00:26:04,800 --> 00:26:08,119
Speaker 2: something called an HSA, a health savings account, and the

527
00:26:08,200 --> 00:26:11,440
Speaker 2: idea is that you and probably your employer would put

528
00:26:11,480 --> 00:26:14,840
Speaker 2: money away and save it and it would grow tax free,

529
00:26:15,160 --> 00:26:18,280
Speaker 2: and you could use that for medical expenses, either things

530
00:26:18,280 --> 00:26:21,520
Speaker 2: that weren't covered by your insurance or things that would

531
00:26:21,520 --> 00:26:25,119
Speaker 2: eventually be covered by your insurance once you hit your deductible.

532
00:26:25,240 --> 00:26:27,960
Speaker 2: It's a kind of catastrophic insurance. It says you're going

533
00:26:28,040 --> 00:26:31,119
Speaker 2: to pay this chunk up front, and if you really

534
00:26:31,200 --> 00:26:34,120
Speaker 2: need a lot of medical care, then your insurance will

535
00:26:34,200 --> 00:26:36,359
Speaker 2: kick in. The problem with this is that a lot

536
00:26:36,400 --> 00:26:39,040
Speaker 2: of people have HDHP plans and they don't have the

537
00:26:39,200 --> 00:26:41,679
Speaker 2: hsas that go with them, so they just have a

538
00:26:41,720 --> 00:26:45,480
Speaker 2: really high deductive health plan. That's an issue. The idea

539
00:26:45,560 --> 00:26:47,840
Speaker 2: is that they're supposed to be coupled with the health

540
00:26:47,840 --> 00:26:51,480
Speaker 2: savings accounts. Now. Health savings accounts were criticized a lot

541
00:26:51,520 --> 00:26:54,000
Speaker 2: when they were first started by people who were all for,

542
00:26:54,119 --> 00:26:56,880
Speaker 2: you know, universal coverage, but they said they mostly help

543
00:26:56,960 --> 00:26:59,520
Speaker 2: the rich. They help people who earn enough or to

544
00:26:59,560 --> 00:27:02,439
Speaker 2: take it saves money, yeah, to put money away that

545
00:27:02,480 --> 00:27:04,560
Speaker 2: they might need for health care. On the other hand,

546
00:27:04,600 --> 00:27:07,120
Speaker 2: if you're young, it's pretty good savings vehicle.

547
00:27:07,840 --> 00:27:10,600
Speaker 4: So we talked about how like an HSA can come

548
00:27:10,720 --> 00:27:12,960
Speaker 4: with a high deductible health plan. But there's also this

549
00:27:13,000 --> 00:27:15,760
Speaker 4: account called the FSA. So where exactly does that come

550
00:27:15,760 --> 00:27:18,600
Speaker 4: into play, and what is the difference between these two accounts?

551
00:27:18,640 --> 00:27:20,280
Speaker 3: Is one like better than another?

552
00:27:21,080 --> 00:27:24,320
Speaker 2: There's a big difference. An FSA flexible spending account is

553
00:27:24,600 --> 00:27:27,760
Speaker 2: generally offered by an employer, and it says we will

554
00:27:27,760 --> 00:27:30,440
Speaker 2: take money out of your paycheck and we will put

555
00:27:30,440 --> 00:27:33,399
Speaker 2: it away and you can use it for medical expenses

556
00:27:33,560 --> 00:27:37,080
Speaker 2: tax free, which is very handy. So I would I

557
00:27:37,119 --> 00:27:40,520
Speaker 2: go to the doctor it costs three hundred dollars. I

558
00:27:40,560 --> 00:27:42,840
Speaker 2: haven't hit my deductible, so I now have three hundred

559
00:27:42,880 --> 00:27:45,320
Speaker 2: dollars bill that I've paid. I send it off and

560
00:27:45,359 --> 00:27:48,159
Speaker 2: it comes out of my get it back through my

561
00:27:48,200 --> 00:27:51,320
Speaker 2: flexible spending account, and I haven't paid taxes on the

562
00:27:51,359 --> 00:27:54,760
Speaker 2: income that's gone to finance that. There's some catches. If

563
00:27:54,840 --> 00:27:58,080
Speaker 2: you don't use up all the money within a certain time,

564
00:27:58,240 --> 00:28:00,520
Speaker 2: you can lose it. If you leave your within a

565
00:28:00,520 --> 00:28:02,480
Speaker 2: certain time, you can lose it. These rules have been

566
00:28:02,560 --> 00:28:04,600
Speaker 2: expanded a little bit, so it's a little bit more

567
00:28:04,640 --> 00:28:07,480
Speaker 2: flexible than it used to be. There's also some things

568
00:28:07,480 --> 00:28:09,159
Speaker 2: that you can spend it on and some things that

569
00:28:09,200 --> 00:28:11,960
Speaker 2: you can't. There's certain amounts of I believe you can

570
00:28:12,280 --> 00:28:15,639
Speaker 2: once again use it for over the counter products. You

571
00:28:15,640 --> 00:28:17,720
Speaker 2: could for a while and then you couldn't, and I

572
00:28:17,880 --> 00:28:20,639
Speaker 2: believe you now can again. So it's worth it to check.

573
00:28:21,040 --> 00:28:23,719
Speaker 2: But it's also a good way, you know, depending on

574
00:28:23,760 --> 00:28:27,399
Speaker 2: your tax bracket, it's a handy way to use tax

575
00:28:27,440 --> 00:28:30,159
Speaker 2: free money for medical expenses. Again, it's a way of

576
00:28:30,280 --> 00:28:33,880
Speaker 2: encouraging people to put money away to pay medical expenses

577
00:28:33,920 --> 00:28:34,959
Speaker 2: that insurance doesn't.

578
00:28:35,600 --> 00:28:39,120
Speaker 1: But Julie FSA, though, does not increue interest the same

579
00:28:39,160 --> 00:28:40,400
Speaker 1: way an HSA does.

580
00:28:41,080 --> 00:28:43,560
Speaker 2: No, that's correct. It just sits in an account and

581
00:28:43,640 --> 00:28:46,960
Speaker 2: there's an administrator and sometimes I mean, in my case,

582
00:28:47,000 --> 00:28:49,200
Speaker 2: you know my RFSA, I have a little credit card.

583
00:28:49,280 --> 00:28:51,720
Speaker 2: So when I go to the pharmacy and I need

584
00:28:51,760 --> 00:28:53,760
Speaker 2: to pay my thirty dollars, cope, I just hand them

585
00:28:53,800 --> 00:28:56,120
Speaker 2: the FSA credit card and then it goes through them.

586
00:28:56,320 --> 00:29:00,720
Speaker 2: But no, an HSA is an actual savings ACCOUNTESSA is

587
00:29:00,840 --> 00:29:03,120
Speaker 2: just sort of a place to kind of park money

588
00:29:03,120 --> 00:29:03,600
Speaker 2: for a year.

589
00:29:04,320 --> 00:29:06,600
Speaker 1: What kind of yield interest yield are we talking here

590
00:29:06,600 --> 00:29:07,560
Speaker 1: with these hsas.

591
00:29:07,800 --> 00:29:09,880
Speaker 4: Yeah, it's actually very similar to a retirement account where

592
00:29:09,880 --> 00:29:12,640
Speaker 4: you could invest in an innexx s and P five

593
00:29:12,720 --> 00:29:14,160
Speaker 4: hundred sort of a fund.

594
00:29:14,160 --> 00:29:16,800
Speaker 2: Exactly is a retirement account for medical expenses.

595
00:29:22,480 --> 00:29:24,720
Speaker 1: There are a number of different things you can pay

596
00:29:24,760 --> 00:29:28,280
Speaker 1: for using an HSA or an FSA, including menstrual care

597
00:29:28,360 --> 00:29:32,480
Speaker 1: products and sometimes even acupuncture. The biggest difference between the

598
00:29:32,520 --> 00:29:36,240
Speaker 1: two options. An HSA accrues interest and can be rolled

599
00:29:36,240 --> 00:29:39,280
Speaker 1: over from year to year, whereas an FSA you have

600
00:29:39,320 --> 00:29:40,800
Speaker 1: to use everything you have by the end of the

601
00:29:40,840 --> 00:29:43,880
Speaker 1: year or you lose it. However, your eligibility for an

602
00:29:44,040 --> 00:29:47,640
Speaker 1: HSA is dependent upon which health insurance plan you choose,

603
00:29:48,000 --> 00:29:50,840
Speaker 1: and often hsas are not offered when you have a

604
00:29:50,840 --> 00:29:54,520
Speaker 1: low deductible plan and you can no longer contribute to

605
00:29:54,560 --> 00:29:57,960
Speaker 1: an HSA. Once you enroll in Medicare, you can still

606
00:29:58,080 --> 00:30:00,480
Speaker 1: use what you have in an HSA, but you won't

607
00:30:00,480 --> 00:30:03,400
Speaker 1: be able to keep putting money into it, which leads

608
00:30:03,400 --> 00:30:06,040
Speaker 1: me to a very important point. And don't trudge me

609
00:30:06,120 --> 00:30:08,479
Speaker 1: for not knowing this, because I know I'm not the

610
00:30:08,480 --> 00:30:11,880
Speaker 1: only one. But what is medicare and what is the

611
00:30:11,920 --> 00:30:14,600
Speaker 1: difference between Medicare and Medicaid.

612
00:30:16,560 --> 00:30:21,280
Speaker 2: Medicare is the federal health program for people who are elderly,

613
00:30:21,360 --> 00:30:25,960
Speaker 2: over sixty five and people with disabilities who qualify because

614
00:30:25,960 --> 00:30:28,640
Speaker 2: they have worked long enough to be eligible for Social

615
00:30:28,720 --> 00:30:31,960
Speaker 2: Security disability. So if you're over sixty five or you're

616
00:30:32,000 --> 00:30:36,680
Speaker 2: on Social Security disability, you are eligible for Medicare. Medicare

617
00:30:36,720 --> 00:30:40,240
Speaker 2: has a number of parts. The hospital part comes for free,

618
00:30:40,280 --> 00:30:43,480
Speaker 2: that's what you pay your payroll taxes. For the optional

619
00:30:43,600 --> 00:30:47,560
Speaker 2: part B you pay premiums for it. And now as

620
00:30:47,600 --> 00:30:50,720
Speaker 2: of two thousand and three, you can buy prescription drug

621
00:30:50,760 --> 00:30:53,320
Speaker 2: coverage because, believe it or not, until then, Medicare didn't

622
00:30:53,320 --> 00:30:57,240
Speaker 2: cover prescription drugs really, yeah, which was really bizarre.

623
00:30:57,640 --> 00:31:00,680
Speaker 1: Yeah, especially since the older you get there or medications

624
00:31:00,680 --> 00:31:01,600
Speaker 1: I feel like you need.

625
00:31:02,400 --> 00:31:04,560
Speaker 2: That's why they didn't cover it because it would have

626
00:31:04,560 --> 00:31:08,920
Speaker 2: been really expensive, so nobody had wanted to add it. Anyway.

627
00:31:09,160 --> 00:31:12,320
Speaker 2: That is Medicare, So that is all federal program. There's

628
00:31:12,480 --> 00:31:14,920
Speaker 2: obviously a lot of private insurance involved in it now

629
00:31:15,200 --> 00:31:17,360
Speaker 2: for people who are older and who are on Social

630
00:31:17,360 --> 00:31:22,480
Speaker 2: Security disability. Medicaid is for people with low incomes, and

631
00:31:22,560 --> 00:31:24,479
Speaker 2: it used to be you had to fit into a

632
00:31:24,640 --> 00:31:27,280
Speaker 2: category to get Medicaid. You had to be low income,

633
00:31:27,320 --> 00:31:30,320
Speaker 2: and a child low income, and a pregnant woman, low

634
00:31:30,360 --> 00:31:33,200
Speaker 2: income and elderly. There's many people who are on both

635
00:31:33,240 --> 00:31:37,360
Speaker 2: Medicare and Medicaid low income with a disability. As of

636
00:31:37,440 --> 00:31:39,720
Speaker 2: the Affordable Care Act, you no longer had to be

637
00:31:39,760 --> 00:31:42,720
Speaker 2: low income and something else. You only had to be

638
00:31:42,800 --> 00:31:45,960
Speaker 2: low income. This was a huge change because there were

639
00:31:46,000 --> 00:31:49,480
Speaker 2: a lot of adult and many young people who had

640
00:31:49,520 --> 00:31:52,280
Speaker 2: low incomes but were not a child or a pregnant

641
00:31:52,280 --> 00:31:56,200
Speaker 2: woman or somebody with a disability, so they were suddenly

642
00:31:56,240 --> 00:31:59,920
Speaker 2: eligible for Medicaid. The trick was that the federal government

643
00:32:00,080 --> 00:32:02,440
Speaker 2: made this an option for the states, so they didn't

644
00:32:02,480 --> 00:32:04,680
Speaker 2: have to do it under the Affordable Care It was

645
00:32:04,720 --> 00:32:07,880
Speaker 2: a very attractive option. The federal government paid one hundred

646
00:32:07,960 --> 00:32:11,240
Speaker 2: percent of the state share for the first three years

647
00:32:11,480 --> 00:32:15,479
Speaker 2: and still pays ninety percent. Now Medicaid is a joint

648
00:32:15,520 --> 00:32:19,440
Speaker 2: federal state program. Wealthier states have to pay half of

649
00:32:19,480 --> 00:32:21,800
Speaker 2: the Medicaid costs. So for the federal government to say

650
00:32:21,840 --> 00:32:23,360
Speaker 2: we're going to pay the whole thing for three years

651
00:32:23,360 --> 00:32:25,520
Speaker 2: and then we're going to pay ninety percent was a

652
00:32:25,640 --> 00:32:30,160
Speaker 2: gigantic incentive. Hospitals were dying to have states do this

653
00:32:30,280 --> 00:32:33,080
Speaker 2: because all of those people who didn't have any insurance

654
00:32:33,080 --> 00:32:35,600
Speaker 2: would show up at the hospital, a hospital would take

655
00:32:35,640 --> 00:32:38,440
Speaker 2: care of them, hospital would have nobody to bill. So

656
00:32:39,000 --> 00:32:42,160
Speaker 2: at this point most of the states have taken advantage

657
00:32:42,160 --> 00:32:44,640
Speaker 2: of it, but there are still I believe it's ten

658
00:32:44,760 --> 00:32:48,920
Speaker 2: hold out states that have not expanded Medicaid. And those

659
00:32:49,000 --> 00:32:52,560
Speaker 2: do include some really big states like Texas and Florida

660
00:32:52,680 --> 00:32:56,520
Speaker 2: and Georgia, and then other states in the South and

661
00:32:57,360 --> 00:32:59,640
Speaker 2: some of the Great Plain states. But the vast majority

662
00:32:59,680 --> 00:33:03,800
Speaker 2: of state now have expanded Medicaid. And so basically, if

663
00:33:03,840 --> 00:33:06,160
Speaker 2: you have a low enough income, you can get health

664
00:33:06,160 --> 00:33:09,000
Speaker 2: insurance through this joint federal state program.

665
00:33:09,360 --> 00:33:12,000
Speaker 4: And so for the people who maybe listening that would

666
00:33:12,080 --> 00:33:14,240
Speaker 4: qualify as being low income, how might they go about

667
00:33:14,280 --> 00:33:15,760
Speaker 4: taking advantage of Medicaid.

668
00:33:16,360 --> 00:33:18,960
Speaker 2: There should be a state Medicaid office. If you just

669
00:33:19,120 --> 00:33:23,000
Speaker 2: google your state's Medicaid program, it should come up. If

670
00:33:23,000 --> 00:33:25,680
Speaker 2: you go to the Affordable Care Act exchanges, the place

671
00:33:25,720 --> 00:33:28,760
Speaker 2: where you buy private insurance. There's supposed to be something

672
00:33:28,800 --> 00:33:31,560
Speaker 2: called the no Wrong Door policy where if you type

673
00:33:31,640 --> 00:33:34,959
Speaker 2: in all of your statistics and your income qualified, you

674
00:33:35,040 --> 00:33:39,760
Speaker 2: automatically get sent to Medicaid enrollment. Also, if you end

675
00:33:39,840 --> 00:33:43,560
Speaker 2: up in a hospital or a community health center. A

676
00:33:43,560 --> 00:33:47,320
Speaker 2: lot of places the providers themselves will help you enroll

677
00:33:47,360 --> 00:33:49,280
Speaker 2: in Medicaid because that's how they're going to get paid.

678
00:33:49,320 --> 00:33:51,360
Speaker 2: So there are a lot of people with incentives to

679
00:33:51,440 --> 00:33:54,239
Speaker 2: get you medicaid if you're in fact eligible for it.

680
00:33:54,880 --> 00:33:57,240
Speaker 1: Julie, Matt and I have been going back and forth

681
00:33:57,280 --> 00:34:00,160
Speaker 1: on this because we've both chosen very different plans for

682
00:34:00,200 --> 00:34:06,200
Speaker 1: various reasons. But between an high deductible health plan with

683
00:34:06,240 --> 00:34:10,480
Speaker 1: a health savings account versus a PPO POS where you

684
00:34:10,520 --> 00:34:14,600
Speaker 1: have a broader network and a lower deductible, which one

685
00:34:14,640 --> 00:34:17,640
Speaker 1: do you think is a better plan to use? For

686
00:34:17,760 --> 00:34:19,799
Speaker 1: somebody like Matt and myself, I.

687
00:34:19,760 --> 00:34:22,640
Speaker 2: Think it's an absolute personal choice. It has to do

688
00:34:22,719 --> 00:34:25,120
Speaker 2: with what level of risk, how much do you worry

689
00:34:25,160 --> 00:34:28,640
Speaker 2: about using healthcare or not using healthcare or saving for

690
00:34:28,719 --> 00:34:32,360
Speaker 2: the future. I mean it is they both have their places,

691
00:34:32,440 --> 00:34:34,920
Speaker 2: and it's the nice thing about having choices. It is

692
00:34:34,920 --> 00:34:38,239
Speaker 2: an individual decision. I could not recommend one over the other.

693
00:34:38,560 --> 00:34:40,319
Speaker 1: That's right. You heard it here. My choice is right,

694
00:34:42,400 --> 00:34:45,080
Speaker 1: so's mass.

695
00:34:45,440 --> 00:34:47,920
Speaker 2: So the question is, you know, it's a talk about

696
00:34:47,960 --> 00:34:49,920
Speaker 2: you know, taking your amount of risk. Do you think

697
00:34:49,960 --> 00:34:52,480
Speaker 2: you're not going to use any healthcare during the year,

698
00:34:52,560 --> 00:34:54,760
Speaker 2: then you might want to go with the lowest premium

699
00:34:54,800 --> 00:34:57,279
Speaker 2: plan you can find, and you might not have to

700
00:34:57,280 --> 00:34:59,160
Speaker 2: pay that deductible. If you don't use any care, you

701
00:34:59,160 --> 00:35:01,839
Speaker 2: don't have to pay a ductductible. So if you do

702
00:35:01,960 --> 00:35:04,359
Speaker 2: think you might be using medical care during the year,

703
00:35:04,400 --> 00:35:07,080
Speaker 2: and hint, hint, people should use at least some medical

704
00:35:07,120 --> 00:35:10,239
Speaker 2: care during the year. They're preventive stuff that you should have.

705
00:35:10,440 --> 00:35:12,759
Speaker 2: But if you think you can just you know, write

706
00:35:12,800 --> 00:35:14,560
Speaker 2: a check for that, pay it yourself, put it on

707
00:35:14,600 --> 00:35:17,040
Speaker 2: your credit card, whatever, then you might want to go

708
00:35:17,160 --> 00:35:19,799
Speaker 2: with some kind of a high deductible health plan. If

709
00:35:19,840 --> 00:35:22,520
Speaker 2: your employer offers to put money in an HSA, if

710
00:35:22,560 --> 00:35:25,400
Speaker 2: you take that high deductible health plan, all the better.

711
00:35:25,719 --> 00:35:27,399
Speaker 2: And if you can put a little bit of money

712
00:35:27,400 --> 00:35:30,160
Speaker 2: in that HSA, it shields it from taxes for you,

713
00:35:30,200 --> 00:35:32,960
Speaker 2: and it's hields it and the employer sometimes will put

714
00:35:33,000 --> 00:35:35,440
Speaker 2: in enough money to make up a good chunk of

715
00:35:35,480 --> 00:35:38,320
Speaker 2: your deductible, so that can be that can be a

716
00:35:38,320 --> 00:35:41,680
Speaker 2: good choice, particularly for younger workers who are less likely

717
00:35:41,760 --> 00:35:45,080
Speaker 2: to need medical care and more sensitive to the amount

718
00:35:45,080 --> 00:35:48,120
Speaker 2: of the premium. If you have doctor's health providers that

719
00:35:48,200 --> 00:35:50,880
Speaker 2: you are very attached to you should find a plan

720
00:35:50,920 --> 00:35:53,920
Speaker 2: that includes them. If you have certain prescription drugs that

721
00:35:53,960 --> 00:35:56,879
Speaker 2: you take, you should make sure that the plan includes them.

722
00:35:57,000 --> 00:36:00,600
Speaker 2: So there's homework to be done, but only it's how

723
00:36:00,680 --> 00:36:03,239
Speaker 2: much do you want to pay out of pocket? How

724
00:36:03,320 --> 00:36:05,759
Speaker 2: much do you think you might have to pay as

725
00:36:05,800 --> 00:36:09,080
Speaker 2: a deductible, and who and what is covered. Those are

726
00:36:09,120 --> 00:36:11,680
Speaker 2: the things you need to sort of go through, either

727
00:36:11,880 --> 00:36:14,200
Speaker 2: with an employer plan, and most employers offer you a

728
00:36:14,280 --> 00:36:16,440
Speaker 2: choice of at least a couple of plants, or with

729
00:36:16,520 --> 00:36:18,560
Speaker 2: an Affordable Care Act plan. No matter what I mean,

730
00:36:18,560 --> 00:36:20,400
Speaker 2: the good news is that you're going to have some choice.

731
00:36:20,520 --> 00:36:22,040
Speaker 2: The bad news is you're going to have to figure

732
00:36:22,040 --> 00:36:24,240
Speaker 2: out which choice is best.

733
00:36:25,800 --> 00:36:28,920
Speaker 1: While some coverage differs from plant to plan, the Affordable

734
00:36:28,920 --> 00:36:31,719
Speaker 1: Care Act has required that certain things are covered by

735
00:36:31,960 --> 00:36:36,320
Speaker 1: any plan, like well woman visits, birth control prescriptions, certain

736
00:36:36,400 --> 00:36:40,200
Speaker 1: vaccines like the flu shot, preventive care like mammograms and kolonoscopies,

737
00:36:40,320 --> 00:36:44,440
Speaker 1: and dental envision coverage for children. However, if you are

738
00:36:44,440 --> 00:36:48,000
Speaker 1: an adult, dental envision are not a requirement of your

739
00:36:48,000 --> 00:36:50,120
Speaker 1: medical coverage.

740
00:36:51,239 --> 00:36:53,439
Speaker 4: So we've got a medical plan, but then we find

741
00:36:53,480 --> 00:36:55,799
Speaker 4: out dental envision are not included.

742
00:36:56,000 --> 00:36:56,799
Speaker 3: Why is that?

743
00:36:57,880 --> 00:37:01,480
Speaker 2: Again, they're expensive, it's an add on. It's not something

744
00:37:01,480 --> 00:37:05,920
Speaker 2: that has traditionally been part of health insurance because.

745
00:37:05,920 --> 00:37:06,480
Speaker 3: La la la.

746
00:37:06,719 --> 00:37:08,960
Speaker 2: It didn't used to be that expensive. It wasn't an

747
00:37:08,960 --> 00:37:13,000
Speaker 2: insurable event. Now it's expensive. Low vision care still most

748
00:37:13,040 --> 00:37:16,160
Speaker 2: vision care is still not that expensive, but dental care

749
00:37:16,200 --> 00:37:19,360
Speaker 2: really is expensive. And again, like mental health care, we

750
00:37:19,440 --> 00:37:22,520
Speaker 2: didn't used to think that it was really important medically,

751
00:37:22,560 --> 00:37:25,840
Speaker 2: but it turns out oral health care is really important medically.

752
00:37:26,200 --> 00:37:29,480
Speaker 2: Uncared for teeth can cause heart disease, right in addition

753
00:37:29,560 --> 00:37:33,160
Speaker 2: to other things. I mean, it is really important. Medicare

754
00:37:33,200 --> 00:37:37,200
Speaker 2: still doesn't cover either dental care or eye care or

755
00:37:37,280 --> 00:37:39,520
Speaker 2: hearing aids. You can see it in There are some

756
00:37:39,680 --> 00:37:43,120
Speaker 2: private Medicare plans that do sort of as an enticement,

757
00:37:43,520 --> 00:37:46,960
Speaker 2: but standard Medicare does not. The health insurance business has

758
00:37:47,000 --> 00:37:50,920
Speaker 2: grown up slowly, shall we say, since the early nineteen hundreds.

759
00:37:51,600 --> 00:37:54,560
Speaker 2: At first it was just hospitals that you needed insurance for,

760
00:37:54,640 --> 00:37:58,480
Speaker 2: and then hospitals and doctors, and then hospitals and doctors

761
00:37:58,560 --> 00:38:02,560
Speaker 2: and prescription drugs, hospitals and doctors and prescription drugs, and

762
00:38:03,200 --> 00:38:06,560
Speaker 2: vision care and dental care and mental health care and

763
00:38:06,600 --> 00:38:09,000
Speaker 2: substance abuse care. There's a lot of things that make

764
00:38:09,040 --> 00:38:12,120
Speaker 2: it expensive, and insurance basically is trying to spread the

765
00:38:12,239 --> 00:38:15,319
Speaker 2: risk to the people who are healthy and who are sick.

766
00:38:15,360 --> 00:38:17,520
Speaker 2: And if it's too expensive for the people who are healthy,

767
00:38:17,719 --> 00:38:19,480
Speaker 2: they won't buy it, and if they don't buy it,

768
00:38:19,520 --> 00:38:23,280
Speaker 2: we get into that insurance death spiral. I'm also curious.

769
00:38:23,400 --> 00:38:27,040
Speaker 1: You know, it's wonderful that well women's visits are included

770
00:38:27,120 --> 00:38:30,799
Speaker 1: in our standard care, but why isn't fertility included as

771
00:38:30,840 --> 00:38:33,920
Speaker 1: part of that kind of well women's coverage?

772
00:38:34,400 --> 00:38:38,200
Speaker 2: Because it's expensive. Almost whenever you ask, there's only two

773
00:38:38,239 --> 00:38:42,000
Speaker 2: reasons why things aren't covered. They're not sort of accepted

774
00:38:42,160 --> 00:38:46,280
Speaker 2: as standard treatment. This is actually why obesity drugs aren't

775
00:38:46,320 --> 00:38:49,279
Speaker 2: covered for the most part, because until very recently, there

776
00:38:49,320 --> 00:38:52,320
Speaker 2: weren't any that worked. There just weren't any good obesity

777
00:38:52,320 --> 00:38:54,040
Speaker 2: to drugs. It was easy to say we're not going

778
00:38:54,120 --> 00:38:56,520
Speaker 2: to pay for them because there wasn't anything that we

779
00:38:56,640 --> 00:38:59,960
Speaker 2: knew scientifically worked that you could pay for. The other

780
00:39:00,160 --> 00:39:03,200
Speaker 2: thing is for things that were really expensive, and infertility

781
00:39:03,239 --> 00:39:06,840
Speaker 2: coverage is really expensive. And question is, you know, is

782
00:39:07,040 --> 00:39:10,440
Speaker 2: an inability to get pregnant? You know, a medical problem

783
00:39:10,920 --> 00:39:13,279
Speaker 2: and it varies, so I actually I'm read I now

784
00:39:13,320 --> 00:39:16,200
Speaker 2: found the statistics. So, as of September twenty twenty three,

785
00:39:16,360 --> 00:39:19,120
Speaker 2: twenty one states plus the District of Columbia have passed

786
00:39:19,120 --> 00:39:23,080
Speaker 2: fertility insurance coverage laws. Fifteen of those laws include IVF

787
00:39:23,160 --> 00:39:27,319
Speaker 2: coverage and seventeen cover fertility preservation. For instance, if you

788
00:39:27,400 --> 00:39:31,000
Speaker 2: are a young woman diagnosed with breast cancer, you can

789
00:39:31,000 --> 00:39:33,160
Speaker 2: have your eggs harvested so that you can get pregnant

790
00:39:33,200 --> 00:39:34,880
Speaker 2: after your treatment, if that's possible.

791
00:39:35,400 --> 00:39:37,240
Speaker 4: Is there any sort of advice you can give someone

792
00:39:37,280 --> 00:39:39,080
Speaker 4: to going through this process for the first time? Is

793
00:39:39,080 --> 00:39:41,440
Speaker 4: there anything that we didn't cover? And then lastly, like,

794
00:39:41,520 --> 00:39:44,120
Speaker 4: do you have any like hope for the future that

795
00:39:44,160 --> 00:39:48,000
Speaker 4: this is going to get like less complex or easier

796
00:39:48,000 --> 00:39:48,600
Speaker 4: to navigate?

797
00:39:48,880 --> 00:39:49,280
Speaker 3: Yeah?

798
00:39:49,480 --> 00:39:51,200
Speaker 1: How do you see it changing and evolving too?

799
00:39:52,080 --> 00:39:53,560
Speaker 2: Well? One thing I will say is that there are

800
00:39:53,640 --> 00:39:57,279
Speaker 2: lots of sources of help. There are navigators for the

801
00:39:57,320 --> 00:39:59,759
Speaker 2: Affordable Care Act. If you look at your state CELTHIC

802
00:39:59,840 --> 00:40:03,080
Speaker 2: ch Sure into Exchange, there are various counselors. You can

803
00:40:03,239 --> 00:40:05,799
Speaker 2: talk to an agent who can help you sort of

804
00:40:05,800 --> 00:40:08,160
Speaker 2: sort through this. You can talk to a trusted adult

805
00:40:08,239 --> 00:40:11,040
Speaker 2: who's been through this who can help you sort through it.

806
00:40:11,120 --> 00:40:14,120
Speaker 2: I mean, it's not easy, and you probably, certainly the

807
00:40:14,160 --> 00:40:16,839
Speaker 2: first or second or third time, should reach out and

808
00:40:16,880 --> 00:40:21,440
Speaker 2: get help. It's not intended to be easy. Am I optimistic?

809
00:40:22,480 --> 00:40:24,279
Speaker 2: You know? Twenty years ago I said things we're going

810
00:40:24,360 --> 00:40:27,120
Speaker 2: to have to really get bad before we really fix things.

811
00:40:27,160 --> 00:40:29,440
Speaker 2: And things are really bad, and we really you know,

812
00:40:29,480 --> 00:40:32,680
Speaker 2: we fix things a tiny, tiny piece at a time.

813
00:40:33,600 --> 00:40:35,360
Speaker 2: Do I think it's going to get fixed? Yeah? Do

814
00:40:35,400 --> 00:40:37,799
Speaker 2: I think it's going to get fixed anytime soon? Not

815
00:40:37,960 --> 00:40:38,840
Speaker 2: so much anymore.

816
00:40:39,200 --> 00:40:40,719
Speaker 4: So the best thing you can do is really arm

817
00:40:40,760 --> 00:40:43,680
Speaker 4: yourself with information and figure out how it's going to

818
00:40:43,719 --> 00:40:44,279
Speaker 4: work best for you.

819
00:40:45,080 --> 00:40:48,799
Speaker 1: Julie, where can we find you and find more great

820
00:40:48,840 --> 00:40:53,000
Speaker 1: advice about healthcare plans and insurance, et cetera. Where's the

821
00:40:53,000 --> 00:40:55,840
Speaker 1: best way to kind of continue to follow your work?

822
00:40:56,560 --> 00:40:59,839
Speaker 2: I am at KFF healthnews dot org. We have us

823
00:41:00,040 --> 00:41:02,759
Speaker 2: separate page for our podcast. KFF Health News is what

824
00:41:02,800 --> 00:41:05,440
Speaker 2: the Health. We come out every week. We cover health

825
00:41:05,440 --> 00:41:09,040
Speaker 2: policy news and we have interviews with health policy newsmakers,

826
00:41:09,080 --> 00:41:12,719
Speaker 2: and we try to make it understandable for everybody. So

827
00:41:12,880 --> 00:41:16,840
Speaker 2: you can subscribe, as they say, wherever you get your podcasts.

828
00:41:16,280 --> 00:41:16,839
Speaker 3: I will say.

829
00:41:17,200 --> 00:41:18,920
Speaker 4: In doing a lot of the research for this episode,

830
00:41:19,080 --> 00:41:22,080
Speaker 4: I stumbled across a lot of KFF videos and before

831
00:41:22,080 --> 00:41:23,960
Speaker 4: I even really put two and two together, they were very,

832
00:41:24,080 --> 00:41:24,560
Speaker 4: very helpful.

833
00:41:24,600 --> 00:41:27,040
Speaker 1: The work that you guys do is very, very cool, amazing.

834
00:41:27,160 --> 00:41:30,480
Speaker 1: I feel way more empowered with open enrollment coming up.

835
00:41:30,560 --> 00:41:32,760
Speaker 1: I seriously feel like I'm going to make some changes

836
00:41:32,800 --> 00:41:35,680
Speaker 1: to my to my what I normally choose after having

837
00:41:35,719 --> 00:41:36,719
Speaker 1: this conversation with you.

838
00:41:36,960 --> 00:41:40,040
Speaker 4: Julie, thank you so much for sharing your time, your expertise,

839
00:41:40,120 --> 00:41:41,760
Speaker 4: everything we really appreciate.

840
00:41:41,800 --> 00:41:43,239
Speaker 3: Thank you for being with us this afternoon.

841
00:41:43,400 --> 00:41:45,560
Speaker 2: Oh sure this was fun. I mean, this is this

842
00:41:45,600 --> 00:41:46,279
Speaker 2: is what I do.

843
00:41:53,280 --> 00:41:56,480
Speaker 1: Wowow wow wow wow. Healthcare in the United States is

844
00:41:56,800 --> 00:41:59,759
Speaker 1: complicated and there are a lot of different options and

845
00:42:00,120 --> 00:42:02,799
Speaker 1: exceptions to consider. Here's what I'm going to take with

846
00:42:02,840 --> 00:42:06,520
Speaker 1: me from our conversation with Julie. The Affordable Care Act

847
00:42:06,560 --> 00:42:09,600
Speaker 1: was monumental in the way it changed the requirements for

848
00:42:09,719 --> 00:42:13,959
Speaker 1: medical coverage and overall accessibility of health insurance and care.

849
00:42:14,840 --> 00:42:18,640
Speaker 1: There's no one, singular, superior health plan option that fits

850
00:42:18,640 --> 00:42:21,879
Speaker 1: for everyone. It all depends on what level of risk

851
00:42:21,920 --> 00:42:24,120
Speaker 1: you're comfortable with and how much you want to pay

852
00:42:24,160 --> 00:42:28,120
Speaker 1: for your regular monthly cost or premium. If you don't

853
00:42:28,160 --> 00:42:29,799
Speaker 1: think you're going to go to the doctor that much

854
00:42:29,840 --> 00:42:32,680
Speaker 1: in a single year, then go with a higher deductible

855
00:42:32,719 --> 00:42:35,960
Speaker 1: plan that allows you to pay a lower premium. If

856
00:42:35,960 --> 00:42:38,279
Speaker 1: you're more risk averse and want to make sure you're

857
00:42:38,360 --> 00:42:40,680
Speaker 1: not going to pay a ton if something bad happens

858
00:42:41,320 --> 00:42:44,399
Speaker 1: and you can manage a higher premium payment, then find

859
00:42:44,440 --> 00:42:47,319
Speaker 1: yourself a plan with a lower deductible. Once you reach

860
00:42:47,360 --> 00:42:50,640
Speaker 1: your deductible, your plan begins to increase its coverage, but

861
00:42:51,320 --> 00:42:54,640
Speaker 1: once you reach your out of pocket maximum, they should

862
00:42:54,680 --> 00:42:59,200
Speaker 1: be covering pretty much everything until the end of the year. Sadly,

863
00:42:59,360 --> 00:43:02,160
Speaker 1: there are a lot of things that are not included

864
00:43:02,200 --> 00:43:04,920
Speaker 1: in the balance towards your deductible or the out of

865
00:43:04,960 --> 00:43:09,080
Speaker 1: pocket max, including copays and other medical expenses that your

866
00:43:09,080 --> 00:43:13,560
Speaker 1: health plan doesn't cover. Hsas versus fssays HSA is a

867
00:43:13,640 --> 00:43:16,560
Speaker 1: crew interest, but are only available with certain health insurance

868
00:43:16,600 --> 00:43:20,279
Speaker 1: plans and your total balance and an HSA rolls over

869
00:43:20,600 --> 00:43:24,680
Speaker 1: year over year. An FSA or flexible savings account is

870
00:43:24,719 --> 00:43:27,040
Speaker 1: a place to park your money and it's a user

871
00:43:27,120 --> 00:43:29,680
Speaker 1: or lose it policy without any rolling balances at the

872
00:43:29,800 --> 00:43:33,760
Speaker 1: end of the year. However, Unlike an HSA, one hundred

873
00:43:33,760 --> 00:43:36,799
Speaker 1: percent of your elected amount is available on day one

874
00:43:36,880 --> 00:43:40,680
Speaker 1: with an FSA. Dental health is important. Don't forget to

875
00:43:40,680 --> 00:43:44,560
Speaker 1: floss well. Woman. Visits to your gynecologists are required by

876
00:43:44,560 --> 00:43:46,719
Speaker 1: a law to be covered in your health insurance plan.

877
00:43:47,800 --> 00:43:50,680
Speaker 1: Our current system is complex and figuring it out is

878
00:43:50,719 --> 00:43:53,600
Speaker 1: a lot to cover for just one episode, but there

879
00:43:53,680 --> 00:43:55,640
Speaker 1: are a lot of resources out there that can help

880
00:43:55,719 --> 00:43:58,680
Speaker 1: us better understand what our options are, and hopefully this

881
00:43:58,800 --> 00:44:01,160
Speaker 1: was a good starting point for you you. We may

882
00:44:01,239 --> 00:44:04,680
Speaker 1: revisit some of the more specifics around health insurance or

883
00:44:04,719 --> 00:44:08,360
Speaker 1: even just broader healthcare and upcoming episodes, but for now,

884
00:44:08,680 --> 00:44:11,319
Speaker 1: that's all for this episode. Matt, what is next on

885
00:44:11,400 --> 00:44:15,560
Speaker 1: this terrifying but rewarding road trip of grown up stuff?

886
00:44:15,840 --> 00:44:21,240
Speaker 4: Speaking of terrifying, our next episode is dropping on Halloween, which,

887
00:44:21,520 --> 00:44:24,000
Speaker 4: if you were a child, might be a festive holiday

888
00:44:24,040 --> 00:44:26,200
Speaker 4: that involves dressing up in scary costumes, But if you're

889
00:44:26,200 --> 00:44:28,319
Speaker 4: an adult and you listen to this podcast, it is

890
00:44:28,360 --> 00:44:30,239
Speaker 4: throwing on whatever is in your closet with some sort

891
00:44:30,280 --> 00:44:31,840
Speaker 4: of animal ears and drinking alcohol.

892
00:44:32,239 --> 00:44:34,760
Speaker 3: So we will be learning how to drink like adults.

893
00:44:34,760 --> 00:44:36,960
Speaker 1: Oh thank god, because not only will it be Halloween.

894
00:44:37,000 --> 00:44:39,040
Speaker 1: But then right after that there's the holiday season, and

895
00:44:39,080 --> 00:44:41,800
Speaker 1: I have got a lot of friends givings and holiday

896
00:44:41,800 --> 00:44:44,040
Speaker 1: parties to attend, and I really want to be the

897
00:44:44,320 --> 00:44:47,880
Speaker 1: Nigdoni spagliato type of adult, But right now I am

898
00:44:47,880 --> 00:44:50,600
Speaker 1: still the can you make a Shirley temple with alcohol

899
00:44:50,640 --> 00:44:51,600
Speaker 1: in it? Type of adult?

900
00:44:51,760 --> 00:44:52,759
Speaker 3: Do you actually order that?

901
00:44:53,000 --> 00:44:54,800
Speaker 1: Yes, it's called a dirty Shirley and it's just a

902
00:44:54,840 --> 00:44:56,680
Speaker 1: Shirley temple with alcohol in it.

903
00:44:56,920 --> 00:44:58,960
Speaker 4: Well, look, we all can't be Emma Darcy in order

904
00:44:59,000 --> 00:45:02,279
Speaker 4: a Nigroni spucky prosecco, but we can all learn how

905
00:45:02,280 --> 00:45:05,640
Speaker 4: to become refined and sophisticated beverage shrinkers in two weeks

906
00:45:05,719 --> 00:45:07,680
Speaker 4: on grown up stuff, how to adult, and.

907
00:45:07,719 --> 00:45:10,600
Speaker 1: Remember you might not be graded in life, but it

908
00:45:10,680 --> 00:45:11,440
Speaker 1: never hurts to do.

909
00:45:11,400 --> 00:45:12,880
Speaker 3: Your homework or floss your teeth.

910
00:45:13,280 --> 00:45:16,480
Speaker 1: This is a production from Ruby Studios from iHeartMedia.

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00:45:16,520 --> 00:45:18,960
Speaker 3: Our executive producers are Malli Sosha.

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00:45:18,840 --> 00:45:22,480
Speaker 1: And Matt Stillo. This episode was engineered by Matt Stillo.

913
00:45:22,440 --> 00:45:24,720
Speaker 3: And written by Molly Soosha.

914
00:45:25,320 --> 00:45:28,520
Speaker 1: This episode was fact checked by Kasby Bias.

915
00:45:28,120 --> 00:45:30,160
Speaker 3: With additional editing by Sierra Spreen.

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00:45:30,480 --> 00:45:33,040
Speaker 1: We want to thank our teammates at Ruby Studios, including

917
00:45:33,040 --> 00:45:36,520
Speaker 1: Ethan Fixel, Rachel Swan, Krasnoff, Amber Smith, Deborah Garrett, and

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00:45:36,520 --> 00:45:39,360
Speaker 1: Andy Kelly.