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.
Health Coverage & Self Employed
Being your own boss is exciting! You’re in control and doing something that more than likely you’re passionate about! Being self-employed could mean anything from owning your own business to working a steady freelance contracting gig. Whatever it is, you’re walking the tightrope of being your own boss and being in charge of everything including your health coverage. That’s where things can not only get confusing but costly. Being self-employed, you miss out on the luxury of having employer-sponsored health plans that your employer paid upward of 50% of the monthly premium. If your business is booming and you do not receive any subsidies for reduced monthly premiums on the marketplace exchange. You could be paying a pretty penny for health coverage. Coverage that you don’t even use too often. Owning your own business is a big deal. Making sure you have the right coverage being self-employed is also a big deal. Being self-employed & healthy can benefit you when it does come to coverage options. Private options with nationwide PPO networks, can not only be more affordable if you can qualify but reduce your out-of-pocket exposure without jeopardizing levels of coverage. Which is very important for someone running a business. If you are self-employed and feel you are overpaying or starting to looking into your own health coverage option. reach out today and let a benefit specialist show you all your available options and advise and educate you through the process to determine which plan is best for you.
Health Coverage for Nurses
The past almost 2 years have been well, a lot on our nurses. From being on the front lines, being hero’s saving lives, to being overworked and understaffed. They have been through and risked their health the most in the few years. Our nurses of course have to protect themselves as well. Now a good portion of nurses have health coverage through their employer which is great bc they are at a minimum paying 50% of monthly premiums.
What about our travel nurses? Who basically jump Into the fire of the hotspots of covid-19. Unfortunately, for most travel nurses, health benefits are not offered to them. So they check the marketplace exchange and realize they can get coverage but it’s in a restricted HMO or EPO network that only covers in that specific zip code they reside in. Unfortunately, that type of network wouldn’t be sufficient for a travel nurse, simply bc when they now travel outside of their resident zip code they have no coverage. Risking and jeopardizing your health daily working in covid hotspots and not having the proper coverage isn’t a risk I would advise taking.
Most people, nurses especially would benefit from being in a nationwide PPO network. Where you have coverage anywhere in the nation and have the freedom and flexibility to even go outside of the network if need be. Now, PPO networks are extremely limited on the federal marketplace exchange. They are available on the private market. If you are a travel nurse and do not have the right coverage for you or no coverage at all reach out today speak to a benefit specialist to review all your available coverage options. Even if you are not a nurse and travel frequently being in a nationwide PPO network would benefit you. You want to be covered anywhere you go, being in a nationwide PPO network provides that!
Overpaying for Health Coverage that you don’t use?
Health Coverage is designed for you an individual to pay medical claims that typically we wouldn’t be able to afford. Of course, we want it coverage our small claims as well. However, the main purpose of health coverage is to cover catastrophic claims, that’s the real reason why we obtain health coverage. We don’t get auto insurance for oil changes and tire rotations, we get it for the major stuff. However, without receiving a government subsidy to reduce premium costs. Plans on the federal exchange can be well, expensive. With large out-of-pocket exposure. Now for someone who doesn’t use their health coverage very often and is relatively healthy. Why are they going to want to overpay for health coverage they do not use? Fortunately, when relatively healthy there are plans on the private market that are based upon health NOT income like it is on the marketplace exchange. These plans are typically in nationwide PPO networks that do not limit your network like HMO & EPO networks, they typically carry very low out-of-pocket exposure and carry very affordable monthly premiums. You ask how is that possible? Well, Insurance in its self is about risk pooling. When the risk pool is unhealthy and you have guaranteed issued plans like on the marketplace exchange, more claims are going to be submitted. The insurance company has to offset the claim loss they are going to receive. How do they do that? They raise the monthly premiums and out-of-pocket exposure. A healthy risk pool has fewer claims naturally, which in turn the insurance company can reduce monthly premiums and out-of-pocket exposure. Now, this isn’t saying that the marketplace is a bad thing bc, in fact, it’s great for individuals who do make a lower income and can qualify for a subsidy and or have major medical issues, bc they cannot be denied coverage on the marketplace per the ACA. However, if you are healthy and or do not receive a government subsidy for reduced premiums there are more affordable coverage options with less out-of-pocket exposure available. I always advise you to review all your coverage options and to speak with a licensed specialist prior to making any decisions regarding coverage. Reach out today and speak to one of our licensed benefit specialists and review all your avilable coverage options.
EXTENDED OPEN ENROLLMENT
The Biden Administration will be extending the Enrollment period under the affordable care act for 30 days. The usual enrollment period on the federal exchange is Nov 1st to Dec 15th, now it’s Jan 15th. Giving more time to enroll in coverage. In addition carriers like United Health Care are expanding their footprint on the federally facilitated marketplace. However, Private health coverage options are available all year long before and after the open enrollment period. No need to wait till Nov to review available coverage options. Reach out today to review all available coverage.