13. October 2016 · Comments Off on Florida Health Insurance – Take Advantage of the Internet’s Price Transparency · Categories: Health Insurance
07. October 2016 · Comments Off on Top Tips For Buying Affordable Health Insurance · Categories: Health Insurance

· First things 1st, Protect yourself

Never, Never, Never let your health insurance lapse. If your new insurance doesn’t come through or your health conditions have changed you may not be eligible for similar coverage at a similar price.

· Avoid fraudulent insurance plans

Always, Always go with a large well known company. Small or unknown insurance companies that aggressively fight for you to sign up and have lower rates than comparable plans of larger companies are a bad bad sign. They sign up thousands of individuals in good health then suddenly when people start submitting claims the insurance company starts dramatically increasing their rates. Clients in good health go elsewhere but those with health issues get stuck. The insurance company may continue increasing rates and reducing benefits leaving you stuck between a rock and a hard place.

Call your states insurance department and make sure the insurance agent and company are legitimate, and licensed in your state. Most fraudulent plans are sold over the Internet or through direct mail solicitations.

Always use a check, money order or credit card when buying a policy so that you have a record of your purchase. Never pay cash and avoid direct withdrawal and automated payments at least for several statement periods. Never make payments to the agent, only to the insurance company.

Never be pressured by “one time deals” or “last chance offers for special savings”.

· Know what your buying

Remember if it sounds too good to be true, it probably is.

When comparing health plans, check the “Exclusions” first. One of the first things an experienced agent looks at in a health insurance plan is the list of plan exclusions, or what is not covered. Often found in small print, what is not covered is equally if not more important than what is.

Comparing policies and providers is a must in today’s high cost insurance market. Using a website or agent that compares multiple providers and plans is the best way to ensure your getting the best policy for the right price, but remember if a policy is significantly cheaper, beware.

· Important notes of interest

Smoking will dramatically raise the policy prices of your health and life insurance plans.

Locking into a health insurance policy when your young will help you ensure long term affordable coverage since getting health insurance when your older, or have established medical issues is much more difficult and costly.

Having some individual health insurance is far better than having nothing at all. With no rehabilitation benefits you could lose your job, in turn losing everything you’ve worked for.

· What are your needs?

Are you planning on starting a family, and therefore in need of both maternity and child coverage, including immunizations? A problem newborn can easily accumulate $200,000 in advanced medical care. Therefore a plan with maternity benefits can shoot up costs. Overall, buy the best policy you can afford to keep.

Would you like your office and/or hospital visits included in your coverage? Do you need coverage for prescriptions? Be sure to consider your current and future needs when shopping for insurance.

Do not inquire about health insurance until you have fully evaluated your present and past medical conditions. An Individual Health Insurance Company may elect not to cover your conditions, or they may pump up the normal premium rates.

If you have serious health conditions you might try to see if Blue Cross will insure you, keep your current coverage in place if they have a 180 +- day delay for pre-existing conditions.

· How can policy rates be adjusted to be more affordable

Check to see how much lower your premium will be if you opt for a major medical plan with a $1,000, $2,500, or even $5,000 deductible.

I recently switched from an insurance plan with $1000 deductible plus 50% copay to $3500 and $30 copay per office visit. To a 1500 deductible with only 3 office visits paid for per year. I rarely go to the doctor so having to pay for my visits myself wasn’t going to cost me much and my policy was $400 less per quarter, substantially better for me at $1600 per year savings.

Note: not all individual health insurance policies are Major Medical plans. Some are hospital plans with stripped benefits, or just hospital indemnity plans which would limit the amount paid per day for hospitalization.

Check to see if the insurer has one rate for all ages, male and female. Some individual health plans base your rates on age, with females getting lower rates at certain ages, and males getting higher rates.

Get multiple quotes from various insurance companies in order to make your best decision. By comparing companies, you may save some money and find greater benefit plans. Be sure that you are comparing apples to apples, since prices and coverage on different plans will vary.

· There are several types of health plans available to choose

Always try to purchase a Major Medical insurance plan. Most Major Medical plans will pay up to $2,000,000 or more in lifetime benefits.

There are major medical plans available that allow you to customize your coverage and stay within your budget. Health insurance plans that cover all the basics are flexible and affordable. You can pick and choose the coverage and deductible amount you want.

Check out the HMO (Health Maintenance Organization) beware though, an HMO is difficult and resistant, you may have to beg to get a referral approved, even though your doctor insists on it. Plus you select your doctor from their list and only use a certain hospital when necessary.

A PPO (Preferred Provider Organization) offers more flexibility at a higher price.

POS (Point of Service), HSA (Health Savings Account-also known as MSA-medical savings account), and traditional indemnity, which is becoming less common as it is more expensive than the other plans. Carefully compare the pros and cons of each plan, and consider which will be more beneficial to you.

One plan that is gaining popularity fast is a (HDHP) High Deductible Health Plan. Major medical coverage is provided with this type of plan. This type of plan features higher deductibles than other types of health insurance and provides coverage for serious injury and illness. Routine doctor’s visits and exams can be included for as cheap as $19 per month with this plan.

Similar to an HMO, PPO, and POS an HDHP uses a network of doctors and hospitals to provide complete medical care and benefits to it’s members. These networks are very large and have providers wherever you may live in America. Discount medical service is given to members of an HDHP plan allowing you and your insurance company to reduce medical costs which keeps your premium lower.

Many variables are possible with an HDHP health plan such as a high deductible, flexible catastrophic limits, coinsurance, copays, preventive care, and prescriptions. Monthly premium savings can be quite substantial, so be sure to look at a high deductible health plan before you decide to buy a new health insurance policy.

Multiple insurance quotes are available for anyone living in any of the following states, Alabama AL, Alaska AK, Arizona AZ, Arkansas AR, California CA, Colorado CO, Connecticut CT, Delaware DE, District of Columbia DC, Florida FL, Georgia GA, Hawaii H, Idaho ID, Illinois IL, Indiana IN, Iowa IA, Kansas KS, Kentucky KY, Louisiana LA, Maine ME, Maryland MD, Massachusetts MA, Michigan MI, Minnesota MN, Mississippi MS, Missouri MO, Montana MT, Nebraska NE, Nevada NV, New Hampshire NH, New Jersey NJ, New Mexico NM, New York NY, North Carolina NC, North Dakota ND, Ohio OH, Oklahoma OK, Oregon OR, Pennsylvania PA, Rhode Island RI, South Carolina, South Dakota, Tennessee TN, Texas TX, Utah UT, Vermont VT, Virginia VA, Washington WA, West Virginia WV, Wisconsin WI, and Wyoming WY… Compare and Save!

29. July 2016 · Comments Off on Georgia Health Insurance · Categories: Health Insurance

Georgia health insurance offers medical benefits that cover the cost of treatment incurred in a hospital. The coverage provided is comprehensive which includes doctor visits, hospital stays, emergency, prescription, dental care, and mental health care. It serves families, students, kids, employees, workers, self employed, small and large businesses, and retirees.

For the citizens of Georgia, a wide variety of health insurance plans are available to choose from. Each one varies significantly based on the size of deductible and the benefits covered. Individual health insurance, family health insurance, group health insurance, student health insurance, affordable health insurance, health insurance for children only, and temporary health insurance are some of the insurance plans available in Georgia.

In Georgia, health insurance laws and regulations regarding individual health insurance is different from other US states. The law allows insurers to deny the request for individual health insurance based on pre-existing medical condition and current health conditions.

The state of Georgia has moderate insurance regulation which protects both insurance consumers as well as the insurance company. According to “guaranteed renewability provision”, a health insurance policy regulation, an insurance owner is allowed to renew a policy without considering his/her health status.

In Georgia there is no limit on the premiums that the companies can charge for a health plan. Also, the law restricts that an insurer cannot cancel one?s insurance policy based on their health condition or age. In certain states, children of unemployed parents are denied from getting health insurance policy. Through a plan called Peach Care, Georgia State provides opportunity for such children to be insured.

Before purchasing health insurance, it is necessary to compare the different health insurance quotes. An insurance agent or an insurance broker is the right person to help you in finding a health insurance policy that best suits your requirement. Blue Cross Blue Shield of Georgia, Kaiser Permanente, Assurant Health, Celtic Insurance Company, Time Insurance Company, and United Healthcare of Georgia are some of the leading companies that provide excellent health insurance coverage for the citizens of Georgia.

15. July 2016 · Comments Off on Small Business Health Insurance – The Best Policy Is A Great Agent · Categories: Health Insurance

I have been a health insurance broker for over a decade and every day I read more and more “horror” stories that are posted on the Internet regarding health insurance companies not paying claims, refusing to cover specific illnesses and physicians not getting reimbursed for medical services. Unfortunately, insurance companies are driven by profits, not people (albeit they need people to make profits). If the insurance company can find a legal reason not to pay a claim, chances are they will find it, and you the consumer will suffer. However, what most people fail to realize is that there are very few “loopholes” in an insurance policy that give the insurance company an unfair advantage over the consumer. In fact, insurance companies go to great lengths to detail the limitations of their coverage by giving the policy holders 10-days (a 10-day free look period) to review their policy. Unfortunately, most people put their insurance cards in their wallet and place their policy in a drawer or filing cabinet during their 10-day free look and it usually isn’t until they receive a “denial” letter from the insurance company that they take their policy out to really read through it.

The majority of people, who buy their own health insurance, rely heavily on the insurance agent selling the policy to explain the plan’s coverage and benefits. This being the case, many individuals who purchase their own health insurance plan can tell you very little about their plan, other than, what they pay in premiums and how much they have to pay to satisfy their deductible.

For many consumers, purchasing a health insurance policy on their own can be an enormous undertaking. Purchasing a health insurance policy is not like buying a car, in that, the buyer knows that the engine and transmission are standard, and that power windows are optional. A health insurance plan is much more ambiguous, and it is often very difficult for the consumer to determine what type of coverage is standard and what other benefits are optional. In my opinion, this is the primary reason that most policy holders don’t realize that they do not have coverage for a specific medical treatment until they receive a large bill from the hospital stating that “benefits were denied.”

Sure, we all complain about insurance companies, but we do know that they serve a “necessary evil.” And, even though purchasing health insurance may be a frustrating, daunting and time consuming task, there are certain things that you can do as a consumer to ensure that you are purchasing the type of health insurance coverage you really need at a fair price.

Dealing with small business owners and the self-employed market, I have come to the realization that it is extremely difficult for people to distinguish between the type of health insurance coverage that they “want” and the benefits they really “need.” Recently, I have read various comments on different Blogs advocating health plans that offer 100% coverage (no deductible and no-coinsurance) and, although I agree that those types of plans have a great “curb appeal,” I can tell you from personal experience that these plans are not for everyone. Do 100% health plans offer the policy holder greater peace of mind? Probably. But is a 100% health insurance plan something that most consumers really need? Probably not! In my professional opinion, when you purchase a health insurance plan, you must achieve a balance between four important variables; wants, needs, risk and price. Just like you would do if you were purchasing options for a new car, you have to weigh all these variables before you spend your money. If you are healthy, take no medications and rarely go to the doctor, do you really need a 100% plan with a $5 co-payment for prescription drugs if it costs you $300 dollars more a month?

Is it worth $200 more a month to have a $250 deductible and a $20 brand name/$10 generic Rx co-pay versus an 80/20 plan with a $2,500 deductible that also offers a $20 brand name/$10generic co-pay after you pay a once a year $100 Rx deductible? Wouldn’t the 80/20 plan still offer you adequate coverage? Don’t you think it would be better to put that extra $200 ($2,400 per year) in your bank account, just in case you may have to pay your $2,500 deductible or buy a $12 Amoxicillin prescription? Isn’t it wiser to keep your hard-earned money rather than pay higher premiums to an insurance company?

Yes, there are many ways you can keep more of the money that you would normally give to an insurance company in the form of higher monthly premiums. For example, the federal government encourages consumers to purchase H.S.A. (Health Savings Account) qualified H.D.H.P.’s (High Deductible Health Plans) so they have more control over how their health care dollars are spent. Consumers who purchase an HSA Qualified H.D.H.P. can put extra money aside each year in an interest bearing account so they can use that money to pay for out-of-pocket medical expenses. Even procedures that are not normally covered by insurance companies, like Lasik eye surgery, orthodontics, and alternative medicines become 100% tax deductible. If there are no claims that year the money that was deposited into the tax deferred H.S.A can be rolled over to the next year earning an even higher rate of interest. If there are no significant claims for several years (as is often the case) the insured ends up building a sizeable account that enjoys similar tax benefits as a traditional I.R.A. Most H.S.A. administrators now offer thousands of no load mutual funds to transfer your H.S.A. funds into so you can potentially earn an even higher rate of interest.

In my experience, I believe that individuals who purchase their health plan based on wants rather than needs feel the most defrauded or “ripped-off” by their insurance company and/or insurance agent. In fact, I hear almost identical comments from almost every business owner that I speak to. Comments, such as, “I have to run my business, I don’t have time to be sick! “I think I have gone to the doctor 2 times in the last 5 years” and “My insurance company keeps raising my rates and I don’t even use my insurance!” As a business owner myself, I can understand their frustration. So, is there a simple formula that everyone can follow to make health insurance buying easier? Yes! Become an INFORMED consumer.

Every time I contact a prospective client or call one of my client referrals, I ask a handful of specific questions that directly relate to the policy that particular individual currently has in their filing cabinet or dresser drawer. You know the policy that they bought to protect them from having to file bankruptcy due to medical debt. That policy they purchased to cover that $500,000 life-saving organ transplant or those 40 chemotherapy treatments that they may have to undergo if they are diagnosed with cancer.

So what do you think happens almost 100% of the time when I ask these individuals “BASIC” questions about their health insurance policy? They do not know the answers! The following is a list of 10 questions that I frequently ask a prospective health insurance client. Let’s see how many YOU can answer without looking at your policy.

1. What Insurance Company are you insured with and what is the name of your health insurance plan? (e.g. Blue Cross Blue Shield-“Basic Blue”)

2. What is your calendar year deductible and would you have to pay a separate deductible for each family member if everyone in your family became ill at the same time? (e.g. The majority of health plans have a per person yearly deductible, for example, $250, $500, $1,000, or $2,500. However, some plans will only require you to pay a 2 person maximum deductible each year, even if everyone in your family needed extensive medical care.)

3. What is your coinsurance percentage and what dollar amount (stop loss) it is based on? (e.g. A good plan with 80/20 coverage means you pay 20% of some dollar amount. This dollar amount is also known as a stop loss and can vary based on the type of policy you purchase. Stop losses can be as little as $5,000 or $10,000 or as much as $20,000 or there are some policies on the market that have NO stop loss dollar amount.)

4. What is your maximum out of pocket expense per year? (e.g. All deductibles plus all coinsurance percentages plus all applicable access fees or other fees)

5. What is the Lifetime maximum benefit the insurance company will pay if you become seriously ill and does your plan have any “per illness” maximums or caps? (e.g. Some plans may have a $5 million lifetime maximum, but may have a maximum benefit cap of $100,000 per illness. This means that you would have to develop many separate and unrelated life-threatening illnesses costing $100,000 or less to qualify for $5 million of lifetime coverage.)

6. Is your plan a schedule plan, in that it only pays a certain amount for a specific list of procedures? (e.g., Mega Life & Health & Midwest National Life, endorsed by the National Association of the Self-Employed, N.A.S.E. is known for endorsing schedule plans) 7. Does your plan have doctor co-pays and are you limited to a certain number of doctor co-pay visits per year? (e.g. Many plans have a limit of how many times you go to the doctor per year for a co-pay and, quite often the limit is 2-4 visits.)

8. Does your plan offer prescription drug coverage and if it does, do you pay a co-pay for your prescriptions or do you have to meet a separate drug deductible before you receive any benefits and/or do you just have a discount prescription card only? (e.g. Some plans offer you prescription benefits right away, other plans require that you pay a separate drug deductible before you can receive prescription medication for a co-pay. Today, many plans offer no co-pay options and only provide you with a discount prescription card that gives you a 10-20% discount on all prescription medications).

9. Does your plan have any reduction in benefits for organ transplants and if so, what is the maximum your plan will pay if you need an organ transplant? (e.g. Some plans only pay a $100,000 maximum benefit for organ transplants for a procedure that actually costs $350-$500K and this $100,000 maximum may also include reimbursement for expensive anti-rejection medications that must be taken after a transplant. If this is the case, you will often have to pay for all anti-rejection medications out of pocket).

10. Do you have to pay a separate deductible or “access fee” for each hospital admission or for each emergency room visit? (e.g. Some plans, like the Assurant Health’s “CoreMed” plan have a separate $750 hospital admission fee that you pay for the first 3 days you are in the hospital. This fee is in addition to your plan deductible. Also, many plans have benefit “caps” or “access fees” for out-patient services, such as, physical therapy, speech therapy, chemotherapy, radiation therapy, etc. Benefit “caps” could be as little as $500 for each out-patient treatment, leaving you a bill for the remaining balance. Access fees are additional fees that you pay per treatment. For example, for each outpatient chemotherapy treatment, you may be required to pay a $250 “access fee” per treatment. So for 40 chemotherapy treatments, you would have to pay 40 x $250 = $10,000. Again, these fees would be charged in addition to your plan deductible).

Now that you’ve read through the list of questions that I ask a prospective health insurance client, ask yourself how many questions you were able to answer. If you couldn’t answer all ten questions don’t be discouraged. That doesn’t mean that you are not a smart consumer. It may just mean that you dealt with a “bad” insurance agent. So how could you tell if you dealt with a “bad” insurance agent? Because a “great” insurance agent would have taken the time to help you really understand your insurance benefits. A “great” agent spends time asking YOU questions so s/he can understand your insurance needs. A “great” agent recommends health plans based on all four variables; wants, needs, risk and price. A “great” agent gives you enough information to weigh all of your options so you can make an informed purchasing decision. And lastly, a “great” agent looks out for YOUR best interest and NOT the best interest of the insurance company.

So how do you know if you have a “great” agent? Easy, if you were able to answer all 10 questions without looking at your health insurance policy, you have a “great” agent. If you were able to answer the majority of questions, you may have a “good” agent. However, if you were only able to answer a few questions, chances are you have a “bad” agent. Insurance agents are no different than any other professional. There are some insurance agents that really care about the clients they work with, and there are other agents that avoid answering questions and duck client phone calls when a message is left about unpaid claims or skyrocketing health insurance rates.

Remember, your health insurance purchase is just as important as purchasing a house or a car, if not more important. So don’t be afraid to ask your insurance agent a lot of questions to make sure that you understand what your health plan does and does not cover. If you don’t feel comfortable with the type of coverage that your agent suggests or if you think the price is too high, ask your agent if s/he can select a comparable plan so you can make a side by side comparison before you purchase. And, most importantly, read all of the “fine print” in your health plan brochure and when you receive your policy, take the time to read through your policy during your 10-day free look period.

If you can’t understand something, or aren’t quite sure what the asterisk (*) next to the benefit description really means in terms of your coverage, call your agent or contact the insurance company to ask for further clarification.

Furthermore, take the time to perform your own due diligence. For example, if you research MEGA Life and Health or the Midwest National Life insurance company, endorsed by the National Association for the Self Employed (NASE), you will find that there have been 14 class action lawsuits brought against these companies since 1995. So ask yourself, “Is this a company that I would trust to pay my health insurance claims?

Additionally, find out if your agent is a “captive” agent or an insurance “broker.” “Captive” agents can only offer ONE insurance company’s products.” Independent” agents or insurance “brokers” can offer you a variety of different insurance plans from many different insurance companies. A “captive” agent may recommend a health plan that doesn’t exactly meet your needs because that is the only plan s/he can sell. An “independent” agent or insurance “broker” can usually offer you a variety of different insurance products from many quality carriers and can often customize a plan to meet your specific insurance needs and budget.

Over the years, I have developed strong, trusting relationships with my clients because of my insurance expertise and the level of personal service that I provide. This is one of the primary reasons that I do not recommend buying health insurance on the Internet. In my opinion, there are too many variables that Internet insurance buyers do not often take into consideration. I am a firm believer that a health insurance purchase requires the level of expertise and personal attention that only an insurance professional can provide. And, since it does not cost a penny more to purchase your health insurance through an agent or broker, my advice would be to use eBay and Amazon for your less important purchases and to use a knowledgeable, ethical and reputable independent agent or broker for one of the most important purchases you will ever make….your health insurance policy.

Lastly, if you have any concerns about an insurance company, contact your state’s Department of Insurance BEFORE you buy your policy. Your state’s Department of Insurance can tell you if the insurance company is registered in your state and can also tell you if there have been any complaints against that company that have been filed by policy holders. If you suspect that your agent is trying to sell you a fraudulent insurance policy, (e.g. you have to become a member of a union to qualify for coverage) or isn’t being honest with you, your state’s Department of Insurance can also check to see if your agent is licensed and whether or not there has ever been any disciplinary action previously taken against that agent.

In closing, I hope I have given you enough information so you can become an INFORMED insurance consumer. However, I remain convinced that the following words of wisdom still go along way: “If it sounds too good to be true, it probably is!” and “If you only buy on price, you get what you pay for!”

©2007 Small Business Insurance Services, Inc. http://www.smallbusinessinsuranceservices.com

05. June 2016 · Comments Off on The 5 W’s of Marketplace Health Insurance · Categories: Health Insurance

Knowledge based on the 5W’s of marketplace health insurance should serve as a reliable foundation for understanding and choosing coverage which meets the qualifications of the Obama health plan. The 5W’s stand for what, why, who, when and where.

What is marketplace health insurance?

Marketplace health insurance is coverage obtained through one of the governmental health insurance exchanges which provides a minimum standard of benefits known as the essential health benefits as specified by the Patient Protection and Affordable Care Act, referred to by many as ObamaCare. The plans are sold by private insurance companies and generally are HMO and PPO plans. Each plan has a metal designation of bronze, silver, gold, or platinum, depending upon services covered and the actuarial value of the plan. Marketplace health insurance plans cannot deny coverage or charge a higher premium for pre-existing illnesses. They cover some preventive care services.

Why purchase marketplace insurance?

The answer to this question rests in Affordable-Care-Act subsidies, also known as premium tax credits, and whether or not you qualify. Eligibility for Affordable-Care-Act subsidies is based on annual household income provided that income is at least 133% but less than 400% of the federal poverty level beginning in 2014. The premium tax credit calculation is based on a provision of the Affordable Care Act that no American should spend more than 9.5% of household income on medical insurance premiums. Given that provision, Obama-health-plan insurance could be purchased outside of the marketplace from a broker or insurance company. The dollar amount of the annual premium in excess of that allowed under the Affordable Care Act for a given income level could then be claimed as an end-of-the-year deduction during income tax filing. If the coverage is obtained through a health insurance marketplace however, the credit can be applied to the monthly premium of any Obama-healthcare-plan selected, resulting in a lowering of the monthly premium of the plan.

Who is eligible to purchase marketplace insurance?

Marketplace health insurance through the federal or one of the state insurance exchanges is for individuals and families less than 65 years of age or small businesses with 50 or fewer employees. Eligibility includes United States citizenship and/or legal residence. Additionally, one must not be incarcerated.

When does having medical insurance become mandatory, when can I enroll, and when does the penalty for not having insurance take effect?

January 1, 2014 is the date that most United States citizens and legal residents must have medical insurance coverage or suffer a tax penalty of $95 per adult, $47 per child, or 1% of the annual household income (whichever is greater) if one is uninsured as of January 1, 2014 and coverage has not been obtained by February 15, 2014. Open enrollment will extend until the end of March 2014. If you have a qualifying life-changing event however, such as marriage, relocation to another state, loss of job-based insurance or expiration of COBRA coverage, marketplace insurance can be obtained as an exception at times after the closure of the open-enrollment season in March 2014 and in subsequent years.

Where can I purchase marketplace insurance?

If you reside in a state whose health exchanges operated by the federal government you will need to purchase through that exchange. Alternatively, marketplace health insurance can be purchased through a private health insurance exchange if it has contractual authority granted by the federal government to enroll Obama health plan applicants. As of December 1, 2013, residents of the District of Columbia and states with state operated insurance exchanges must obtain marketplace medical insurance through the state exchanges. Those states are Those states are California, Colorado, Connecticut, Hawaii, Idaho, Kentucky, Maryland, Massachusetts, Minnesota, Nevada, New Mexico, New York, Oregon, Rhode Island, Vermont, and Washington.

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