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Health Insurance Planning

When you call us for health insurance, you will feel relieved at how easy we make it! We will consult with you and design a health insurance plan that strikes the balance between quality coverage and affordable costs. We provide a compassionate approach. We take pride in knowing that when we close your file, you are covered for life’s unexpected turns.

Health Insurance 101

Why Do You Need Health Insurance?
Health insurance protects you from the high cost of medical care by providing coverage for specific health care services. Although you generally pay an annual deductible and either co-payments or co-insurance, the cost for insurance is far less than medical care would be if paid cash or fully out-of-pocket.

How Can I Buy Affordable Insurance?

#1. Increase your deductible
As a healthy individual, increasing your deductible will lower your premiums and save you a substantial amount. Make sure you can still afford the cost of your deductible in case you do get sick.

#2. Get it while you’re healthy
Buying a health insurance policy when you’re healthy ensures you can get your application through medical underwriting and have health insurance if you do get sick – and that it is reasonably priced.

#3. Choose a plan from a quality and reliable company
“Cheap” health insurance sounds affordable, but you MUST choose a plan from a solid and reliable company that will be around for it’s promise to pay. Our experience with the carrier’s will guide you toward good quality planning.

#4. Call Our Office Anytime for a Review
We are your advisor. We will review your plan anytime you want to. Simply give us a call and let us know!!! Keeping your insurance for the long term is our priority!

What Are the Differences Between Health Insurance Policies (PPO & HMO)?

What is a PPO?
A PPO (Preferred Provider Organization) is a type of health insurance plan where PPO members seek care within the network of participating doctors and hospitals and pay lower out-of-pocket costs. Members can also seek care from nonparticipating doctors and hospitals, but pay a higher portion of the cost of care. Care is not limited to a primary care doctor or gatekeeper. Members can coordinate their own care and go to any doctor in the network who is a provider. PPO insurance is a plan with more flexibility of what doctors you can visit. It is more flexible than an HMO, but the out of pocket costs are higher.

What is an HMO?
An HMO is a type of managed care health insurance plan that allows you to receive care through a network of participating doctors and hospitals. Generally, you select a primary care physician who is the gatekeeper. This doctor coordinates your care and refers you to specialists when needed. Out-of-network care is generally not covered under an HMO plan, unless the member requires care that is not available in the existing network.

What is a consumer-directed health insurance plan?
Also referred to as “consumer-driven,” or “consumer choice,” this type of health plan gives members more choice and flexibility in making health benefits decisions and more control over their health benefits dollars. These plans often include a health fund or account for covered medical expenses. Depending on the type of fund or account, unused dollars may be rolled over annually to cover medical expenses in subsequent years for the duration of the members’ enrollment in the plan. There are several types of consumer-directed plans, including Health Savings Accounts (HSAs), Health Reimbursement Arrangements (HRAs) and Flexible Spending Accounts (FSAs).

What Is a Health Insurance Premium?
A premium is the payment you and/or your employer pay to your insurance company to purchase a health insurance plan. This can be paid on a monthly, quarterly or annual basis.

How Does a Health Insurance Deductible Work?
A deductible is the amount that you must pay for covered services in one year before the plan will pay benefits. A member of a high-deductible health plan, for example, might be required to pay for the first $1,000 of medical care prior to receiving coverage under the terms of his/her benefits plan. After this, coinsurance and % will kick in. The higher your deductible, the lower your monthly premium payment. Make sure you can afford your deductible for when you get sick and need to use your insurance!

What Is a Co-Payment?
A co-payment is the specified dollar amount or percentage required to be paid by you or on your behalf in connection with benefits. For example, most HMO plans have co-payments in place for certain services such as doctor’s visits, prescription drugs, hospital stays, etc.

What are out-of-pocket costs?
Out-of-pocket costs include premiums co-payments, deductibles, co-insurance or other fees that you are required to pay outside of your health benefits plan.

How do I pick a health insurance plan?
If you have a choice of plans through your employer or you are purchasing your own coverage, it’s important to understand your choices and pick the plan that is right for you and your family. There are several questions to ask yourself when reviewing health insurance plan options:

  • How affordable is the cost of care?
  • How much are monthly premiums?
  • How much are the deductibles?
  • Are the co-payments or co-insurance flat fees or percentages of service fees?
  • What out-of-pocket expenses have to be paid before the plan begins reimbursement? >
  • How does the reimbursement process work?
  • What is the cost of out-of-network care?

Does the plan cover the services that I may use? For example:

  • Doctors, hospitals, laboratories and other health care professionals in the network
  • Out-of-network care
  • Treatments for pre-existing medical conditions or chronic conditions
  • Prescription drugs

What is the quality of the health insurance plan? Research factors of the plan such as:

  • Ratings of the plan by independent government and non-government organizations
  • Accreditation from groups like the National Committee for Quality Assurance (NCQA) or the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
  • Patient complaints
  • Member drop-out rates for the plan
  • Other patient experiences with the plan
  • Doctor experiences with the plan
  • Insurance broker experiences with the plan

What if my employer doesn’t offer health insurance?
Employer-subsidized group coverage for an employee can be less expensive than anything you can get on your own. Spouses and children on Employer plans are not always priced as reasonably. We’ll compare the costs with you. But, if your employer doesn’t offer health insurance, or if you are temporarily unemployed, you should consider purchasing an individual health insurance policy. We’ll find a way to compete with Employer Plans on benefits and cost!

Call us for help at (818) 881-8887 or email