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Healthcare costs
are rising year
after year, and nobody should be without health insurance. Just one unforeseen
medical event, (just
one day
in the hospital can cost in excess of $15,000), could result in a financial
catastrophe for someone who is uninsured. But it also makes sense to shop around
for the best deal—to find the lowest
premium for the appropriate coverage. This
is what we do, ...and have been doing successfully for our clients
since 1986 !
"We're dedicated to helping you find the absolute
best and most affordable health & life insurance coverage available for Individuals, Families
& Groups. Simply put,
we do all the shopping and research...then present it to you, based upon your needs...allowing you to now make
an informed decision."
Today's Major Medical health Insurance
plans come with many varying coverage options. You must have an understanding of how each plan works in order to
make an informed decision as to which type of coverage best suits your needs, a PPO, HMO, HealthSavings Account or a Traditional Indemnity plan... whether
it be coverage for individuals, families or employer groups.
What are
the different types of health insurance plans available?
Generally, there are HMO's, PPO's, HSA's, and POS plans. The HMO (Health
Maintenance Organization) and PPO (Preferred Provider Organization) plans are
both forms of managed care plans that allow you to visit the physicians within
the plan's network. An HSA (Healthcare Savings Account) allows individuals to
contribute money to their Healthcare Savings Account on a pre-tax basis. The
money can then be used to pay future co-payments and deductibles. POS (Point of
Service) plans are a hybrid version of HMO's and PPO's which give you
flexibility in your decisions about what physicians you would like to visit.
Different health insurance companies offer additional options or variations of
the plans described above. Be sure to consult your insurance agent about which
type of plan may be best for your family.
What is
a deductible?
The deductible is the portion of a medical expense that a plan member must pay
before your medical insurance plan will begin to cover any medical expenses. If
your plan deductible is $1,000 then you will pay for the first $1,000 of your
medical expenses before your plan will begin paying for covered medical
expenses. The amount of your chosen deductible can have an effect on your
health insurance premiums.
What is
a co-payment?
A co-payment is a set dollar amount or percentage that the plan member will pay
for each doctor visit or service. A common co-payment percentage is 80/20. This
means that the insurance company will pay 80% of covered medical expenses,
while you will only pay 20%. Co-payment percentages can also effect the
insurance premium the plan member is charged.
Things
to consider when choosing a health insurance plan:
·
What is the monthly or annual cost of the plan?
·
Is there a deductible that must be met before the plan begins to
cover my medical expenses?
·
After the deductible is met what portion of medical expenses will
the plan cover?
·
What kinds of doctors are part of the plan, and where are the
medical facilities located?
Are their limits on the amount of coverage the plan will offer under
certain medical conditions?
Why is one Health Insurance
Plan more expensive than another?
In any competitive market similar
products are closely priced. Then why, you might ask, is there such a difference in premiums?
"Health insurance
is available with many different plan designs in order to provide numerous choices for individuals and families.
These choices can greatly affect the monthly premiums you pay to have coverage."
- A plan with unlimited co-payments for doctor office visits & prescription drugs will have
the highest monthly premium.
- Some insurance plans have limited
the number of doctor co-pay visits per year ( 2 - 4 ) in order to further reduce premiums. Whne your doctor visits
exceed the number covered with the co-payments, you will still have coverage, but will have to pay the reduced
network amount and apply it to your deductible/co-insurance.
- Prescription coverage can also have
a deductible that has to be met before the smaller co-payments can be used.
- Insurance coverage with no co-payments
for either doctor visits & prescriptions will even further reduce premiums. These plans require that medical
expenses be applied to the deductible and/or co-insurance.
- Additionally, single deductible
plans are available that are HSA qualified. HSA qualified plans provide extensive inpatient and outpatient coverage
plus great tax advantages.
- Plans with the absolute lowest premium
will offer in-hospital only coverage with very limited outpatient benefits.
- As you can clearly see,
deciding on the correct coverage for your needs can be very confusing.
"Our experience, honesty,
hard work & integrity will help to find the best insurance plans to meet your needs"
Please review the different
forms of medical coverage available. We are always glad to assist you in finding the right plan to meet your needs,
whether it be individual / family coverage or group coverage for businesses with 2 employees or more.
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Health Savings Accounts (HSAs) --are permanent, portable, tax-favored
savings accounts available to everyone with a high deductible ($1100 - $10,000) health insurance plan.
"HSAs combined with high deductible health insurance plans provide hope for individuals and groups seeking
a way to control the seemingly upward spiral in health care costs."
Many quality HSA plans provide preventative & wellness care to the members, with the deductible/co-insurance
waived for services such as:
- Routine Physical Exams
- Mammography exams
- Routine Colon tests
- Routine pelvic exams
- Routine Pap smear
- Prostate (PSA) screening
- Digital rectal exam
- Immunizations
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There are many important facts
you should know & questions you should ask when evaluating a health plan, such as:
- Does the policy have an annual deductible
& co-insurance, or is it a per-confinement deductible & co-insurance?
- What is co-insurance & stop-loss?
- What is your financial responsibility
after the deductible and at what point will the plan pay 100% of eligible expenses?
Co-insurance examples are 80/20%,
50/50% and 100%. You and the insurance company share the medical expenses until the stop-loss is reached.
- How much are you responsible for
until it does?
Each company has several stop-loss
options you could be responsible for, such as 20% or 50% of either $2500, $5000 or $10,000.
*Beware! There are health plans being offered that have no stop loss…meaning you will
be responsible for 20% or 50% of all medical expenses…with no end in sight! They might be cheaper, but do you want
a plan that could end up costing you $15,000, $20,000 or more?
Is your Stop-Loss calculated
annually or on a per-confinement basis?
· Does the plan have a Doctor Office co-payment and is there a limit on the number of visits?
· How are prescriptions covered?
· Is the plan
a Scheduled Benefits Plan?
Scheduled Benefit Plans only pay a fixed dollar amount for services such as daily hospital semi-private room rate,
daily intensive care, surgeons' fees, miscellaneous services & supplies, etc. These plans are usually inexpensive…but
very limited in coverage and can leave you with a large remaining hospital bill after they have paid.
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