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Do I need Health Insurance?
Most American's are just one (1) illness away from bankruptcy. The reality is that a as much as 60% of all bankruptcies in the United States are due to the inability to pay for medical bills*. Whether you are a young adult and think you are invincible or an older adult who's never had a reason to see the doctor or go to the hospital, you will need health insurance. It only takes a sever case of swine flu or a car accident or a fall of of your roof while hanging Christmas lights to put you in the hospital. How will you and your family pay for that? Nobody call's their house insurance agent while the house is burning to buy home insurance right? Nor can you call the insurance agent AFTER you've had a car wreck to buy that car insurance he's been talking to you about. So true is health insurance. We've had many calls over the years where the individual wants the insurance and will inevitably ask, "How soon can I get this to start?" Then we ask the next question, "How soon do you need it to start?"--that's when we find out that they are no longer eligible to get insurance for some reason---like calling from the emergency room.
IF I decide to get health insurance, what is the cheapest plan?
Everyone is concerned with costs but you have to know what you're willing to trade off. There are several components in a health insurance plans that can be added or removed. So, if you want to get the cheapest rate, what are you willing to give up? Typically the higher deductible will get you the lowest monthly premium. Other things that will lower the rate is: having a small number of doctor office visit co-pay's or none at all, maximum drug coverage, no physical coverage, etc. Most men are fine with no doctor visit co-pay's since men tend to go to the doctor one (1) time a year or to the hospital when duct tape doesn't work on that cut! Women are the oppossite and they want to go to the doctor, at least four (4) times a year, get their annual check ups and they want access to their doctor when they need to go; same is true for children. So, again, what can you do without? It's not uncommon to find a health insurance plan with a $20-$50,000 deductible and with only two (2) doctor office visit co-pay's. However, be cautious with the Association plans that accept all pre-existing conditions or other discount plans.
How does the health insurance deductible work?
Let's look at the whole picture. Typically you have three (3) levels of health insurance with your health insurance company (ie, Blue Cross, Aetna, Humana, etc.). These levels are: 1) Deductible, 2) Co-Insurance and 3) Out-of-Pocket Maximum. As the insured (you), you will have a monthly payment (called the premium) which is 100% your responsibility to pay every month in order to have the health insurance policy in effect. The deductible is the level the insured must reach BEFORE the health insurance company will share the health care bill with the insured. So, if you have a $5,000 deductible, you are responsible to pay $5,000 out of your own pocket before the health insurance company will start to pay their part (normally 50-90% based on your health insurance plan). Now you go into the CO-INSURANCE which subjects you to 10-50% of the costs at this level while the health insurance company pay's the rest. This level has a MAXIMUM amount that you will pay which is called the Out-Of-Pocket Maximum. This amount may vary and can be less than or more than the deductible. For simplicity's sake we will assume it is $4,000. Therefore, the insured in this example will pay their $5,000 deuctible and then a percentage in the CO-INSURANCE phase until they pay out a maximum amount of $4,000 afterwhich the insured will be covered for 100% the remainder of the calendar year. This is good for someone that may have a bill as large as $20,000 or more, but may not be such good coverage if the bill is $10,000.
The deductibles are too high. I want a cheap health insurance plan with no deductible like an HMO plan. Where can I get an HMO plan?
In most cases you can only get an HMO plan through a group employer or retirement plan. Almost all of the health insurance plans offered in Texas, New Mexico, Oklahoma, Georgia, South Carolina, North Carolina and other states are PPO types of plans and will always have a deductible. Again, what are you willing to trade off to get the lower premium?
What's the difference between a health insurance indemnity plan and a traditional PPO plan?
Indemnity plans tend to provide limited amount of coverage and, in most cases, are hospital only types of plans. PPO plans are typically 'all inclusive' plans which cover hospital, doctor, prescriptions, E/R, etc.
What should I look for when buying individual health insurance?
When shopping for a health insurance plan, here are a few things to consider:
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Is the premium an amount you are comfortable paying each month?
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Do you have money set aside that will help cover your deductible?
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Does the health plan cover the benefits you need such as prescription drug coverage, doctor visits and hospitalization?
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If it does not offer you all the benefits you need, is it still your best health insurance plan?
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If you have a regular doctor, is your doctor in the health plan’s network?
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Will you benefit from a High Deductible Health Plan (HDHP) with a Health Savings Account (HSA)?
I'm 64 right now and I don't know what to do?
Those that are 64 need to understand that they need to purchase a health insurance plan BEFORE they reach their 64 1/2 year mark. Most insurance companies will NO LONGER ACCEPT an application after that. Now, if the person purchased the health insurance plan before they reached their 64 1/2 year mark, then they are safe and they can continue to stay on the health insurance plan until they enroll in Medicare. Also, Medicare does allow you to enroll 3 months before you turn 65, but Medicare will not go into effect until the month you turn 65. So, if you are under 64 1/2 then you should consider purchasing a health insurance plan for the short term and it may very well be a Short Term policy you consider.
I'm turning 65 in the next 3 months, what should I do?
Congratulations on turning 65. Now you will get the health insurance you paid for during your working years---Medicare. The first thing is to go down to your local Social Security office and enroll in Medicare if you haven't received your package (most people automatically get the package mailed to them). If you are still working and have group insurance, then you can accept Medicare Part A and waive the Part B AS LONG AS THE GROUP INSURANCE WILL CONTINUE TO COVER YOU. You may also be able to waive the Part D IF your group plan provides drug coverage equal to or better than that required by Medicare. However, if you do not have a group health insurance plan or a retirement plan, then you will need to consider purchasing a Medicare Supplement and a stand-a-lone Part D (prescription drug) plan or enrolling in a Medicare Advantage plan like a Health Maintenance Organization (HMO; like AARP Secure Horizons Medicare Complete), Preferred Provider Organization (PPO; like the Humana plans), Private Fee For Service (PFFS; like the Aetna plans) which may include the Part D plans.
Let's say I decide to go the traditional Medicare Supplement (Medigap) route. How does that work?
Medicare has two parts: Part A and Part B. Part A covers hospitals and has a $1,100 deductible (2010 deductible; paid per confinement). Part B covers doctors and that has a $155 deductilbe (2010 deductible; paid one time a year). Once you pay these deductibles, Medicare will cover 80% of the bills and you will pay 20%. A Medicare Supplement (or Medigap) can pay for the deductibles and the 20% thereby leaving you with only the monthly premium to pay. This is a brief explanation and there are more specifics, but this gives you a general idea. Please speak with our licensed representatives to further understand this topic.
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Have more questions? Call 1-(866)-4542-2442 and talk to a licensed health insurance agent.
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Individual & Family
