What would you like to know about Health Insurance?
What types of health insurance are available? - There are 2 typical plans available today. Indemnity plans which are also known as reimbursement plans and managed care plans such as health maintenance organizations (HMOs), preferred provider plans (PPOs) or point of service plans (POS).
What will health insurance cost me? - There are several factors that determine the premium for your health insurance. Your choice of deductible and co-insurance, your age, health conditions, whether or not you use tobacco, how many you are wanting to cover if it's for a family, are among the factors that determine the premium. To get an accurate quote, you'll want to contact me so we can help you determine your premium.
Do all health insurance plans pay the same toward claims? - There are several different ways in which an insurance company pays claims. Some pay based on usual and customary, some pay on reasonable and some pay based on a predetermined amount. The main thing to remember is when looking at the right insurance company is that you understand how it pays claims, what the exclusions are and what is considered a covered claim.
Where can I get health insurance? - If you work for an employer who provides health insurance benefits, you may normally be able to qualify for the health insurance after a certain length of time after employment starts, usually 90 days. The employer may also require that you work a certain number of hours per week prior to receiving coverage.
If you work for yourself and for an employer who does not offer health insurance, then you may purchase an individual health insurance plan from a licensed agent in the state that you reside. By purchasing a health insurance plan on your own, you will be able to design a plan that best suits your needs and fits your budget.
How do I decide which type of plan is best for me and my family? - In the case of health insurance, lowest cost is not always the best choice. You'll want to take into consideration several factors. Here a few to consider:
What are the copays, deductibles and the coinsurance amounts?
Can I chose my own doctors or is the network limited?
Does the plan cover pre-existing conditions?
Does the insurance company in my state have a good reputation?
Will the plan include my children and how long can they stay on the policy?
Will the insurance company guarantee that my rate will remain the same for a certain period of time, such as 12 months, 2 years or 3 years?
Why does the premium seem to go up every year? Rising health care cost and the fact that you are a year older are the leading reasons why health insurance premiums rise. It may be wise to look at a company that will guarantee that your premium will remain the same for a period of time.
Are Insurance Companies required to issue individual policies to anyone who applies? No they are not. An insurance company may issue a policy as applied for, with exclusions, with added premiums and they may decline an application. If it is declined, you may request in writing why the policy was declined.
I had kidney stones last year. Can the insurance company refuse to pay for other episodes of kidney stones in the future? Yes, and normally the exclusion will last the life of the policy.
Are prescriptions paid for in my policy? You will need to chose your health insurance plan according to your needs and fit your budget. It is very important to ask what is covered and what is not.
Am I required to get prior approval from my insurance company concerning medical services? Often insurance companies will require prior authorization prior to receiving any medical services. There may be other restrictions and requirements in your policy and it is best that you understand these prior to obtaining a plan.
What is a deductible and when does it apply? A deductible is the dollar amount you must pay prior to the insurance company paying for any covered medical expense. A deductible can apply to inpatient and outpatient services as well as to prescription coverage. Normally, the deductible is per person per calendar year. For families, there may be a limit as to the number of deductibles that apply per year. Some policies have a common accident deductible and it is limited to one per common accident. Some deductibles apply per person and per medical condition. It is important to know how your plan works and why.
What is coinsurance and how does it work? Coinsurance is the percentage of covered medical expenses you will pay for after you have met your deductible. For example, if you have an 80/20 plan, you will responsible for 20% of the balance after your deductible is met up to a preset amount. This is known as your coinsurance limit.
If there a maximum amount of medical expenses that I am responsible for paying each year? Some plans limit the amount you have to pay and that's called out-of-pocket maximums. There are sometimes limits that an insurance company will pay per calendar year. Knowing how the plan works will aid in securing your peace of mind during a catastrophic event.
What is the difference between in-network and out-of-network expenses? Depending on the type plan you have, it is best that you go to hospitals and doctors in your network. By using the network, you are receiving coverage from providers that have agreed to negotiated discounts on their health care services. When you use these providers, you realize substantial cost savings on covered services and help keep your out of pocket costs lower.
When you go out of network, you are accessing health care services from providers who have not negotiated their services and you may be required to pay for the amount that the insurance company would have otherwise paid for if you had used a network provider.
Have a question I haven't answered? Ask me.
Please note that the questions here and the answers provided as to be used as a guide only.
