How to choose a good Health Insurance Plan?

Planning for the future and trying to anticipate the unexpected things that life throws us, is no easy task.  Having quality health insurance for you and your family is an important piece to that puzzle.  Peace of mind comes from knowing you have adequate protection for any injury or illness. Unfortunately, there is no perfect health plan that fits everyone’s needs and there’s no one single perfect healthcare provider.  Your first step in selecting a plan that’s right for you is determining what your personal needs are given your current situation.  By following through the questions and answers below, you’ll gain a better understanding of the different plan types and coverage options as well as the terminology associated with health insurance.  Your next step after reviewing all the information below is to get with your Broker so you can design a plan that’s best for you and your family.

If you’re like a lot of people, you only use basic health care services, and don’t want to pay a lot for monthly health premiums.

The best solution for you and your family may be an HSA qualified plan.  This is a plan that uses a higher deductible and provides you the benefit of paying for small things in life such as doctor’s office visits and testing which are normally minor throughout the year along with prescription drugs if needed.  The premium savings normally offset your out of pocket expenses you incur throughout the year.

Example:
PPO or HMO plans with low deductibles            Higher Deductible HSA Plan
Or no deductible

Monthly cost range: 
Single person        $300-$550                                         $100- $300
                Savings per year:               $2,400 - $3,000

Family Plan        $800 - $1200                                          $300 - $600
                Savings per year:                $4,000 - $7,000

If you’re a healthy single person in this example, you would have saved $2,400 to $3,000 for the year.   With this savings, you could easily pay for your doctor’s office visits and prescription drugs throughout the year.  On a 100% coverage plan, once you reach your plan deductible, all costs are covered 100% with most carriers.  Speak to your Broker for specific details.

Health Savings Account (HSA), A Health Savings Account is an alternative to traditional health insurance; it is a savings product that offers a different way for consumers to pay for their health care. HSAs enable you to pay for current health expenses and save for future qualified medical and retiree health expenses on a tax-free basis. 

If your annual health expenses average $1,000 and you save $2,000 per year on monthly premiums, in ten years you would have saved $20,000 tax free if you contributed those savings into your HSA Account.  Each company we represent offers an HSA qualified plan as part of their portfolio of quality health plans.  For additional details, speak to your Broker about which company may be best suited for your particular needs.

If your objective is to pay as little as possible out of your own pocket before your plan begins covering your medical expenses, then you’re probably looking for a low deductible plan.

An HMO or a low deductible PPO plan may be best for your needs.  An HMO has co-payments attached to each medical need you may have.  Doctors office visits could be from $15.00 to $35.00 co-payment.  Hospital stays would be from $200.00 per day to $500.00 per day with a maximum daily limit and outpatient testing would also have co-payments related to them as well.  Speak to your Broker for more details on each carrier plans. 

A Low deductible  PPO plan would provide coverage on hospital stays and out patient testing after a $500.00 to $2,500.00 deductible.  They also have doctors’ office co-payments that may not be subject to the annual deductible as well.  Speak to your Broker for more details.

Your monthly premium payments would be higher than if you had a high deductible plan, but you would not be able to use an HSA account because your plan would pay for the cost above the co pay amounts or low deductible amounts. 

If your goal is to cap the total amount you spend each year on medical expenses, then a low deductible PPO health plan may your best option.

It’s very important to understand that there are penalties charged when you use a provider outside of your Health Plans Network.  Normally an HSA high deductible plan offers the best solution for capping your out of pocket expense. The key reason is because an HSA plan pays for 100% of all expenses after your deductible has been met and they also have set penalties for going outside your network. 

HMO plans and some PPO plans depending on the insurance carrier, do not have set out of pocket limits for going outside their network.  Ask your Broker to explain this in detail.  Your assets could be at risk.

If your circumstance has you visiting the doctor and specialty care providers’ offices often, and you don’t want to pay a lot for these visits, then an HMO or High Deductible PPO is the best solution.

HMO plans and High Deductible PPO plans that have set doctors office co-payments for each visit and no limit on the number of visits each year, would be best suited for your situation.  Most carriers offer a selection of deductibles and co-insurance options to keep the premiums affordable.  It’s important to note, that when an insurance carrier is going to pay for your doctor’s office visits in addition to some wellness visits each year, they will increase your monthly premiums to cover this cost.  With a wide variety of deductible and co-insurance options, you can potentially lower your monthly premiums and still have these desired benefits.  Ask your Broker to explain this in detail.

If you take prescription drug medications frequently and want your plan to cover part of these expenses, you have a lot of options.

The majority of all health plans have prescription drug coverage automatically included or they have the option to add this coverage on.  Depending on your carrier choice, you will have Generic, Brand Name and Preferred Brand Name co-payments and sometimes there is an individual deductible for prescription drugs.  Speak to your Broker to find out whether an HMO, PPO or PPO HSA plan will meet your needs.

I would like my health care expenses to be tax-deductible even if I don't itemize my tax deductions.

An HSA qualified PPO plan would offer these tax deductions.  You can learn more about this option in the Consumer Learning Center or speak to your Broker.

Should I Get An HMO Plan Or A PPO Plan?

HMO (health maintenance organizations) or also known as managed care, are typically more expensive and you are limited to using only their very specific network of doctors and therefore, hospitals as well. If you go anywhere else for your care you will have to pay full price. Your main doctor (primary care physician) will refer you to a specialist if the need is present. You will not simply be able to go wherever. However, many PPO plans now offer more choices to help ease the burden of being so constricted.

PPO (preferred provider organization insurance plans) is more flexible in that you can choose from many more doctors and hospitals because they usually have many other providers also registered with them and you also pay less for that flexibility. These plans come with a wide variety of deductibles to lower the cost. So, you must decide which is more important to you, more flexibility or paying more for insurance.

National Brokers Network is committed to educating you of your options so you can make informed decisions so please speak to your broker or fill out the Get a Free Quote section so a Local Broker in your state can contact you...

How Can I Save On My Health Insurance Plan?

The best way to save on insurance costs is to buy a high deductible HSA qualified plan. Your premium savings will generally offset any out of pocket costs over years of ownership.

Stay healthily! This may seam like a strange comment when lowering your payments but it is the most important. When you become unhealthy your rates will go up substantially and may even prevent you from being able to own insurance in the future when you really need it. When you watch TV today you will see multiple new drugs offering relief from health systems. The key word here is symptoms. The US is the unhealthiest country in the world with more people taking medications fro more things then the rest of the world. Most of the drugs today are only treating symptoms and not providing a cure. National Brokers Network recommends seeing a Medical Doctor with a nutritional background or a Certified Doctor of Naturopathy. It is well documented that the human body is very capable of healing it self if given the right ingredients like food types and supplements our body’s lack. Below are some great resources if you desire to take this cost saving method seriously?

Google the following:

Pompahealthsolutions.com                              Dr Eric Braverman MD   

How to Pick a Good Health Insurance Company?

Each carrier has their own plan coverage details. In terms of deductibles, co-pays and co-insurance, these terms mean the same with each carrier. Most of the limitations found in the plan limitations are generally standardized with each carrier.

The most important thing to find out is what are the limitations pertaining to drug coverage. What are the limitations to providers being utilized? Ask yourself would Tiger Woods go to just any doctor or hospital? Then the question we encourage you to think about is what limitations does my current or possible purchased plan offer?

Everyone has different life styles and needs when considering health coverage, so we encourage you to speak to your broker and receive an understanding of the different plans available to you. Paying more does not always constitute a better quality plan and either does paying the lowest rate. Getting the best provider care and understanding the short falls in each plan along with matching the monthly cost up with your monthly budgeted amount is the way to approach this issue. For some an HMO is the best fit, for some a PPO low deductible plan is the best and for some a low cost high deductible plan with an HSA account is the best solution. That is why National Brokers Network brokers are your best option in understanding what plan will fit your needs. We are not interested in pushing one plan over the next we are interested in helping you meet your needs and retain you as a long term client.

National Brokers Network is committed to educating you of your options so you can make informed decisions so please speak to your broker or fill out the Get a Free Quote section so a Local Broker in your state can contact you...

HSA Accounts

Health Savings Account (HSA) Plans

Health Savings Account plans combines lower-cost, high-deductible health insurance with a tax-advantage health savings account that earns 1% to 3%.

Do you want more control over how your health care dollars are spent?
Health Savings Account (HSAs) plans can help you take control of your health, your medical decisions, and your medical spending. An HSA, also known as a health savings account, can increase your health insurance buying power by:

• Typically lowering your health insurance premium, but still providing quality coverage.
• Regaining more control of your health care dollars.
• Paying your out-of-pocket health care expenses with tax-advantaged savings.
• Spending your HSA savings tax free to help pay your health insurance deductible or for qualified medical expenses including prescriptions, vision, or dental care.
• Providing one simple, calendar-year deductible per family.

For more information visit HSACenter.com. This is a great educational site from Golden Rule on how HSA Accounts work.

Co-Pay Plans

Provide Traditional Insurance Benefits for People Who Need Routine Health Care. Co-pay Plans are similar to traditional coinsurance offered by employer plans that include a copayment for out-of-pocket medical expenses. If you are looking for a plan that offers co pay benefits, preventive care, and prescription drugs then a Co-pay Type Plan may be best suited for you.

When you use a preferred network doctor for an office visit, carriers will pay 100% for history and exam fees after a specific co pay amount. Office expenses outside your network are not eligible for co pay benefits typically.

Additional features include:

• Prescription Drug Card Benefits.
• Comprehensive coverage for inpatient and outpatient medical expenses.

High Deductible Health Insurance Plans

High Deductible Health Insurance Plans offer the lowest premiums of all plans. High Deductible Health Insurance allows you to save money on your premiums while taking the responsibility of covering minor or routine out of pocket medical expenses if they come up. You will also benefit from network discounts passed through to you.

Short Term Health Insurance

Life can change quickly and you may need the protection of short term health insurance.
Short Term Medical Insurance products can be an alternative to COBRA health insurance and can provide temporary health insurance for individuals who may have:

• Lost coverage through recent job or life changes.
• Recently graduated and are no longer covered by your parent's plan.
• A job as a seasonal worker.
• Begun enjoying early retirement and are waiting for Medicare.
• Recently completed COBRA insurance coverage.

Short term health plans offer easy-to-understand temporary medical insurance designed for individuals and families in times of transition and change.

Personal insurance is not the same as COBRA, so review your COBRA information carefully. Your time to elect COBRA is limited by law. Failure to elect will eliminate HIPAA eligibly.

National Brokers Network is committed to educating you of your options so you can make informed decisions so please speak to your broker or fill out the Get a Free Quote section so a Local Broker in your state can contact you. Understanding your Cobra rights and options are critical in making a final decision.

Terms to Become Familiar with

Benefit Period

A specified period of time during which benefits for covered services must be used. For example, a calendar year (January-December) or a contract year (the 12 consecutive months following your effective date of enrollment).

Benefit Period Maximum

The total amount your insurance plan will pay for covered medical expenses during each benefit period.

Calendar Year

The 12-month period beginning on January 1 and ending on December 31.

Coinsurance

A cost-sharing requirement under which you are responsible for paying a certain percentage of the covered medical expenses, after you meet your deductible (if applicable). Example: You have a 100k hospital bill and a plan with a 5k deductible and 80% / 20% co insurance.

100k Hospital bill
5k Deductible
95k Balance

You would pay 20% of the 95k with a maximum out of pocket that varies from carrier to carrier and the carrier would pay 80% and then 100% above your maximum out of pocket. There could be additional costs over and above this if you use providers who are out of the carrier’s network they provide. This is very important issue please speak to your Broker concerning each carriers plan design.

Contract Year

The period of 12 consecutive months following the effective date of your agreement and each subsequent 12-month period that the agreement is in effect.

Co-payment

A cost-sharing requirement under which you are responsible for paying a set dollar amount for covered medical expenses. Some plans require you to meet your deductible first and others don’t. This is very important issue please speak to your Broker concerning each carriers plan design.

Deductible

Amount you must pay out of your own pocket before the plan begins to pay for any covered services.

Effective Date

The date, as shown in you carriers records, on which your health care coverage began.

Guaranteed Issue

Plans that accept all applicants without regard to the applicant’s state of health.

Medically Underwritten

Plans that base acceptance for enrollment on your health status, determined by the answers you give on a medical questionnaire

Health Savings Account (HSA)

A savings account for out-of-pocket medical expenses in which contributions and interest earned are tax-exempt and withdrawals are tax-free if funds are used for eligible medical expenses. An HSA is used in conjunction with a high deductible health plan.

High Deductible Health Plan (HDHP)

A health plan that offers substantial savings in monthly premiums in conjunction with higher-than-usual deductible levels. When you enroll in a qualified HDHP, you may be able to take advantage of the tax savings offered by a Health Savings Account (HSA).

Health Maintenance Organization (HMO)

A health care program that provides coverage only for those eligible services received within the insurance carrier’s provider network. There is no reimbursement to you if you use a doctor or hospital that does not participate in the carrier’s network (unless it is an emergency).

Lifetime Maximum

The total amount your insurance plan will pay for covered medical expenses while you are enrolled in your plan. With some carriers they also limit how much of the lifetime maximum you can use per year. This is very important issue please speak to your Broker concerning each carriers plan design.

Networks

These are companies that have negotiated lower rates with providers such as Doctors, Hospitals, Outpatient care facilities and other health care providers. Some insurance carriers have their own network contracts with these providers. Every insurance carrier will either use their own network or they will buy the services of an independent network company to keep their costs lower when you utilize the plan. These discounted rates get passed down to you if you buy a plan where you’re deductible needs to be met first. When calling a provider to check whether or not they participate with your insurance carrier, always tell them what network your carrier uses. It is not unusual for a provider not to recognize your carrier but will recognize the network provider. This is very important issue please speak to your Broker concerning each carriers plan design.

Non-participating Providers

Providers that do not have agreements with the network your carrier is providing to you. These providers may “balance bill" you for any differences between the carriers payment amount and the provider’s actual charges. Insurance carriers who pay UCC verse RCC give you more protection against and financial surprises when you utilize your plan. This is very important issue please speak to your Broker concerning each carriers plan design.

Out-of-pocket Maximum

The maximum amount you will pay out of your own pocket for covered medical expenses during a given benefit period. Normally this requires that you stay within the network your carrier provides. Some companies have limits even if you are out of the network while others don’t. This is very important issue please speak to your Broker concerning each carriers plan design.

Participating Providers

Providers that have agreements with Networks to accept carriers payment amounts as payment-in-full for covered services (after any applicable deductibles, co-payments or co-insurance).

Pre-existing Condition

A condition for which medical advice or treatment was recommended by a physician or other medical provider within a carrier specified time frame immediately before your effective date of coverage.