Understanding Health Coverage
With Open Enrollment starting on Nov 1st this year, it’s time for us to discuss some of the different coverage options and what to look for. The most important thing is understanding your options, what is good for you and your family might not be for the next person. A lot of factors going into finding the “right plan”, income, health, lifestyle, and even employment. The ACA made it law to cover all pre-existing conditions on the federal marketplace exchange. In addition, depending on your income, subsidies are available for individuals who can qualify based upon their household income, which is great news! Most options on the marketplace these days, with the exception of a couple of states, are HMO plans which only provide coverage in your direct service area & only cover for emergencies outside of the service area. Certain lifestyles and employment whereas you travel frequently or have children in college in different states, more than likely, it’s best to seek a nationwide PPO option which is typically found on the private market. The marketplace isn’t the only option for coverage, there are private underwritten options that are guaranteed renewable plans until 65, there are short-term options, healthshare plans, catastrophic plans. Understing your situation will help a licensed agent narrow down the options that are best for you.
Some of the other factors when choosing a health plan is what is my out-of-pocket exposure. Most people typically “price shop”, they look for the cheapest plan. Which for some people might be appropriate, paying 25 or 50/month for coverage sounds great! Having a deductible of over 8k in a restricted HMO network with a coinsurance of 50% may not be. What does that exactly even mean? Well, it means for most medical services the deductible needs to be satisfied for the insurance to pay claims. That means 8k out of your pocket BEFORE the insurance pays claims. NOT IDEAL! In addition, “coinsurance” is the share amount between you and the insurance company AFTER your deductible is met. So, if it’s 50% that means it paying only half the claims after your deductible. I recently saw a short-term medical plan that had a coinsurance of 15k every 6 months, so that’s 30k per calendar year. Do the math. You are looking at a hefty out-of-pocket expense! Ideally, we pay a monthly premium to cover our medical costs if they arise. 15 min can save you thousands a year not only in monthly premiums but out-of-pocket exposure in the event of a major medical event. Reach out & schedule a free consultation today and speak with a licensed benefit advisor, review ALL avilable coverage options prior to selecting a plan.
