I’m exaggerating, of course, but only barely. If you want to make it a little more complicated, all you’ve got to do is throw in a dash of maternity insurance.

The important thing to keep in mind when you’re dealing with maternity insurance is that most maternity-related expenses are going to have little or nothing to do with your normal benefits. The costs of pre-natal care, delivery, and post-delivery care are almost universally not covered expenses under your normal health plan. The second thing to keep in mind is that if you’re currently pregnant, you’re out of luck. If you don’t already have maternity insurance, you’re not going to be able to add it. Actually, if you don’t currently have health insurance of any sort and you’ve just gotten pregnant, then no major carrier will issue you a health insurance policy of any sort. If that’s the situation you’re in, I suggest checking out your options with state assistance.

The third thing to keep in mind is that maternity insurance on an individual policy can be very pricey, and here’s why: health insurance is all about risk. When a health insurance company issues a policy, they’re hoping that you never, ever, ever get sick or injured, because then they’ll have to pay a claim. If an insurer issues a hundred policies and only one person files a claim, then the insurance company’s expenses are kept low, and that means that their premiums can stay lower. That’s why it’s also more expensive to get health insurance when you’re older or when you have a more colorful health history — you present a bigger risk to the insurance company (in other words, there’s a greater chance that you’ll actually use your health insurance to pay a claim), so they charge you more to accept that risk.

Now, nobody is out trying to get sick or injured, and that means that every year loads of people with health insurance will pay their premiums and not file a claim. Health insurance companies love this, and you should too — fewer claims means lower expenses for insurers, and that means lower premiums. However, as a general rule, nobody buys maternity insurance unless they’re thinking about getting pregnant, and that means the chance of a claim being filed against that insurance policy is much higher than the chance of a claim being filed against a normal health insurance policy. That means that policies that include maternity insurance have significantly higher premiums than policies without it.

Now, what does maternity insurance do?

In a nutshell, maternity insurance covers the costs of pregnancy and delivery. Of course, nothing could be that simple, so let’s elaborate a little.

There are two main ways in which maternity insurance can work.

The first is the method utilized by most insurance companies: subjecting maternity benefits to a maternity deductible separate from the normal medical deductible. So, if you break your leg, your costs associated with that apply to your medical deductible, and that medical deductible is completely separate from your maternity deductible.  Aside from that, maternity benefits structured in this way are pretty normal.

The thing is, many maternity deductibles are pretty high, sometimes up in the $10,000 range, while the usual cost of a routine pregnancy only runs $4000 – $6500. It may seem pretty useless to have a maternity deductible that high, but there is a benefit to it.

As we discussed in the article on high deductible health plans, covered expenses get negotiated rates while non-covered expenses get billed the full amount. As a quick refresher: if you go to the emergency room and don’t have health insurance, you’ll get billed for the full amount of the ER visit (let’s say, just for example, that the cost is $4000). If you do have health insurance, then the insurance company will get a bill from the hospital for $4000, but chances are they won’t pay that much. Instead, they’ll pay the negotiated rate that the hospital has agreed to accept from the insurance company for the services rendered. This means that on a $4000 bill, an insurance company will probably pay $2400-$3200. Well, if you go to the hospital on a high deductible health plan and get that bill for $4000 and you haven’t yet met your deductible, you can generally negotiate to pay that negotiated rate, too. A high deductible maternity benefit works the same way — although you may never meet your deductible, since your maternity expenses are a covered expense you will be able to negotiate a lower rate than you would be able to if you had no maternity insurance at all.

The second way maternity insurance can work is the method employed by United Health Care’s individual division, Golden Rule. With Golden Rule, you get first-dollar benefits, meaning you don’t have to meet a deductible before your insurance starts paying benefits. Instead, you have a sort of bank of $4000 that you can draw on to pay maternity costs. Once you have used up that $4000, you’re responsible for the rest of your maternity costs. To get the full benefit, you’ve got to have the benefit added to your plan for twelve months — trying to use the benefits before that twelve month period is up means you’ve only got access to 50% of the bank, or $2000 worth of benefits. That twelve month waiting period does include conception, so patience is a virtue with this plan.

Depending on the carrier, your maternity benefit may also impose a waiting period for any maternity benefits of anywhere from 90 days to twelve months. Always remember, that waiting period includes conception. Also, maternity benefits cover routine expenses, but even if you don’t have maternity benefits on your health insurance policy, emergencies related to pregnancy (such as having to have an emergency c-section) may be covered. When it comes to maternity benefits, it’s vitally important to have your agent handy to help guide you through your policy.

If you’re contemplating maternity insurance, then that means you’re thinking about bringing a new life into this world – and that’s a huge decision. It’s vitally important that you get the maternity insurance policy that truly fits your personal needs, and the safest way to get the right maternity insurance is to work with an independent insurance agent. Head up to our free Georgia insurance quote page to find out how much your maternity insurance will cost and to get free, expert help in choosing the perfect policy for your new family!

How Maternity Insurance Works is a post from: Georgia Insurance Options

No related posts.

Related posts brought to you by Yet Another Related Posts Plugin.

Aetna coverage is a hot commodity right now, and with good reason – Aetna coverage is among the most affordable types of health insurance available in Georgia today. There are several different types of Aetna coverage, so let’s have a look at what’s on the market.

Aetna Coverage Option One: Managed Choice Open Access & PPO First Dollar 30

The first thing you’ll notice about Aetna coverage is that the plans have frightfully long names.

The Managed Choice Open Access & PPO First Dollar 30 plans are the top of the line when it comes to Aetna coverage. There’s no deductible on these plans – instead, with this Aetna coverage option, you’ll pay 30% of your bills until $7500 comes out of your pocket. After that point, you’ll pay nothing and your Aetna coverage will pay 100%. Office visits are handled by a $30 copay ($40 for specialists). Visits to an urgent care center will run $50 under this Aetna coverage plan, and visits to the ER will cost you $300 flat-fee (unless you’re admitted, in which case this Aetna coverage waives the $300 and goes back to charging you 30% until you’ve reached your annual $7500 out-of-pocket limit). 

Prescription drugs are subject to a $500 deductible. Generics are a $15 copay (deductible waived), so only preferred drugs ($40 copay) and non-preferred drugs ($60 copay) are subject to the deductible with this Aetna coverage.

The Verdict: This Aetna coverage is pretty magnificent, but it carries a magnificent price tag, too. If you want to spend this much on your health insurance, why not limit your out-of-pocket exposure a little more and get a Copay Select plan with Golden Rule?

Aetna Coverage Option Two: Managed Choice Open Access & PPO First Dollar 40

This Aetna coverage is essentially the same as the first, with the following modifications

• This Aetna coverage pays 40% of your bills, not 30%
• The maximum out-of-pocket is $12,500, not $7500
• Office visit copays are each increased by $10
• Brand name drugs are not covered

The Verdict: The lack of prescription benefits with this Aetna coverage really kills it. As always, I never recommend a plan with less than full prescription benefits.

Aetna Coverage Option Three: Managed Choice Open Access & PPO 1500

This Aetna coverage is more in line with what most people think of when they think “health insurance.” Here, we’ve got a $1500 deductible – once that’s met, this Aetna coverage will pay 80% of your bills and you’ll pay 20% until an additional $1500 comes out of your pocket. At that point, your Aetna coverage will pay 100% of your bills.

Office visits with this Aetna coverage are handled by a $25 copay ($35 for specialists). Generic prescriptions cost $15 without meeting any deductible. After a $250 prescription deductible, preferred drugs cost $35 and non-preferred cost $50. 

The Verdict: This Aetna coverage is just about top-of-the-line and carries Aetna’s trademark affordability. This is an excellent option.

Aetna Coverage Option Four: Managed Choice Open Access & PPO 2500

This Aetna coverage is the same as the PPO 1500 with the following modifications:

• There’s a $2500 deductible, then 20% coinsurance to an additional $2500 out-of-pocket (our previous Aetna coverage had $1500, 20%, and $1500)
• Office visit copays are $30 ($40 for specialists)
• Prescription drugs are handled in the same style, but this Aetna coverage carries a $500 prescription deductible instead of $250.

The Verdict: A more affordable version of the 1500 Aetna coverage without any significant holes. Again, an excellent option.

Aetna Coverage Option Five: Managed Choice Open Access & PPO 3500

Again, this Aetna coverage is the same as the PPO 1500 and 2500 with the following modifications:

• There’s a $3500 deductible, then 20% coinsurance, then a $6500 out-of-pocket limit, making the total liability for this plan $10,000
• Office visit copays are $35 ($45 for specialists). 
• Prescription drugs are handled in the same way as with the PPO 2500 Aetna coverage.

The Verdict: This Aetna coverage includes a $6500 out-of-pocket limit, making the total liability on this plan a little too high. The price difference between this Aetna coverage and the PPO 2500 is not large enough to justify the difference in liability.

Aetna Coverage Option Six: Managed Choice Open Access & PPO 5000

Once again, we have a plan that works the same as our previous few options with a couple of modifications:

• This plan has a $5000 deductible, 20% coinsurance, and then a $5000 out-of-pocket limit. This means that the total liability is the same as with the PPO 3500 option, but the deductible is larger.
• Office visits are handled with a $40 copay ($50 specialist).
• Prescription drugs have a $500 deductible and work the same as our last two Aetna coverage options.

The Verdict: If your budget restricts you to this or the PPO 3500, the 3500 will give you greater flexibility and value. However, it’s very much worth the slight price increase to move up to the PPO 2500 and cut your liability in half.

Aetna Coverage Option Seven: Managed Choice Open Access & PPO Value 2000

This Aetna coverage option has the word “Value” in the name, which loyal readers of Georgia Insurance Options will know is code for “watch out – limited benefits ahead.” However, Aetna breaks the mold a bit by offering a robust coverage option and only limiting unnecessary benefits.

Here, you’ll have a $2000 deductible. Once you meet that, you’ll pay 30% of your bills until an additional $2000 comes out of your pocket. At that point, your Aetna coverage will pay 100%. 

You’ve got six office visits per year covered by a copay ($40, or $50 for specialists). Specialist and non-specialists share those six visits under this Aetna coverage option, so budget those visits wisely.

Generic prescriptions are again a $15 copay, and the deductible is waived. Other prescriptions, however, are subject to a $200 prescription deductible with this Aetna coverage option. After that’s met, you’ll pay a $25 copay for preferred drugs and a $40 copay for non-preferred drugs. 

The Verdict: Extremely affordable with low liability means this Aetna coverage option is a great choice for just about anyone. The only people I wouldn’t recommend this plan to are parents with very young children – those six visits will dry up quickly with them.

Aetna Coverage Option Eight: Managed Choice Open Access & PPO Value 5000

Not to sound like a broken record, but this Aetna coverage option is the same as the previous plan with the following modifications:

• You’ll have a $5000 deductible, then 30% coinsurance to an additional $5000 out-of-pocket.
• The prescription deductible is $500, not $200. 

Aside from that, this Aetna coverage option is identical to the previous plan.

The Verdict: This Aetna coverage option is decent if you’re on a budget, but the Value 2000 is far superior and the prices aren’t that far apart. I suggest looking at the Value 2000 Aetna coverage option more closely if you’re considering the Value 5000 plan.

Aetna Coverage Option Nine: Managed Choice Open Access & Value 10000

This Aetna coverage option is flat-out bad. 

First, you’ve got a $10,000 deductible. Once you meet that, you’ll pay 30% of your bills until you pay an additional $2500 out of pocket for a total liability of $12,500.

You’ve got two office visits per year covered by a $30 copay. After that, under this Aetna coverage option your office visits begin falling to your deductible.

Generic drugs under this Aetna coverage option cost $20, no deductible. After a $500 deductible you can get preferred drugs for $40, but non-preferred drugs aren’t covered. On top of that, there is a maximum prescription benefit of $5000 per year for prescription drugs – meaning if you’re on $8,000 a round outpatient cancer treatment drugs, you’ll be out of pocket for everything after the first round.

As a final straw, this Aetna coverage option has a $1,000,000 lifetime maximum benefit. Seems like a lot until you realize that the standard is usually $5,000,000 and some plans in Georgia go up as high as $25,000,000

The Verdict: This Aetna coverage option is bad, bad, bad. However, admittedly, it’s the cheapest health insurance plan in the state of Georgia. If you absolutely, positively cannot afford anything else, then this Aetna coverage option is technically better than nothing.

Aetna Coverage Option Ten: Managed Choice And Open Access Preventative and Hospital Care 1250

This one’s no good either.

First, you’ll have a $1250 deductible with this Aetna coverage option. After you meet that, you’ll pay 20% until an additional $3000 comes out of pocket. At that point, you’ll be covered at 100%.

Office visits are not covered expenses, meaning that with this Aetna coverage option you’ll not only pay for the entire bill for your doctor’s visits, but that amount won’t apply to your deductible and you won’t get network repricing. Horrible!

Labs and X-Rays aren’t covered either. Neither is physical therapy or durable medical equipment (like wheelchairs, crutches, etc.). Again, “not covered” means you’ll not only pay for them, but the cost won’t apply to your deductible with this Aetna coverage.

Preventative care under this Aetna coverage is handled well, giving you unlimited visits at $25 a pop – but who goes for preventative checks more than once or twice a year?

Finally, you’ll get your generic drugs at $15 each, but brand-name drugs are not covered. That’s the final nail in the coffin of this Aetna coverage.

The Verdict: I sat here for ten minutes trying to think of a reason why you should buy this Aetna coverage, and I didn’t come up with a single one. A resounding “NO.”

Aetna Coverage Option Eleven: Managed Choice Open Access and PPO Preventative & Hospital Care 3000

Somehow, worse than the 1250 Aetna coverage.

This Aetna coverage is probably the single most offensively awful thing I’ve ever come across. You’ve got a $3000 deductible, 20% coinsurance, and then another $2000 out of pocket. Then your Aetna coverage kicks in and pays 100% of your bills.

Again, office visits aren’t covered. Labs and X-Rays aren’t covered. Physical therapy isn’t covered. Durable medical equipment isn’t covered.

Under this Aetna coverage, you don’t even get the $15 generics – there is simply zero prescription drug coverage.

The Verdict: I wouldn’t wish this one on my worst enemy. This Aetna coverage option is the absolute, bottom-of-the-barrel worst health insurance plan offered by any major insurance company in Georgia. It is absolutely, positively unthinkable that there would ever be a situation in which this Aetna coverage option was the right choice for you.

Aetna Coverage Option Twelve: Managed Choice Open Access & PPO High Deductible 3000 (HSA Compatible)

The last two Aetna coverage options are very good and very simple. This Aetna coverage has a $3000 deductible – costs before it come out of pocket, costs after are paid 100% by Aetna. That’s it – doctor’s visits, hospitalizations, prescription drugs, everything. Once you’ve paid $3000, you’re done for the year and your Aetna coverage will pick up the rest. This is an extremely simple HSA style plan with very few moving parts and an integrated prescription deductible.

The Verdict: While this Aetna coverage option is great, it doesn’t offer any advantages over the Humana Autograph Total Rx series of plans. These two often run neck-and-neck as far as pricing goes, so comparison shop. However, as we’ll see in a moment, even if the Humana plan comes out to be $30 a month more expensive I’d probably recommend it over the comparable Aetna coverage.

Aetna Coverage Option Thirteen: Managed Choice Open Access & PPO High Deductible 5000 (HSA Compatible)

This plan is functionally identical to the previous plan – the only difference is that the deductible is $5000 instead of $3000. This, of course, makes the plan slightly more affordable while trading off some of the risk. 

The Verdict: My feelings about this Aetna coverage are the same as they are about its $3000 sister. Compare closely against Humana to see which one works better for you.

Special Considerations

There are a couple of things to consider when you’re looking at an Aetna coverage option. Although the plans are some of the most affordable in the state, Aetna has a reputation for being somewhat difficult to deal with on the billing side. Aetna coverage comes with Aetna bureaucracy, which means increased headaches when it comes to getting bills paid and rates negotiated.

Aetna also has a nasty habit of raising their rates multiple times in the second year of coverage, turning a very affordable Aetna coverage plan into an overpriced bank-drainer. In contrast, Humana and Golden Rule will raise their rates once a year at most, and Assurant will allow you to lock in your rate for up to three years on some plans.

There’s also no option to add maternity to your Aetna coverage, so if you’re planning a family then this isn’t the company for you.

On the positive side, Aetna’s dental coverage is widely regarded as some of the best in the business. It’s accepted across a large range of practitioners and geographic areas and is a very affordable form of dental coverage, too. 

The final verdict on Aetna coverage in general: The plans are affordable (for the first year), but you’ve got to be very careful which one you pick. You could either get awesome Aetna coverage, or be stuck with one of the worst plans in the state – there’s very little middle ground when it comes to Aetna coverage. The company also has a slightly spotted reputation, but it’s still a first-tier carrier and that means it’s miles above no-names like Imerica and World.

In short, Aetna coverage is a good budget option, but probably shouldn’t ever be your first choice. Always compare these plans closely with offerings from Humana and Golden Rule before making your final decision.

Now that you’ve learned more about Aetna coverage than you probably ever wanted to know, it’s time to find out how much it costs! Head on over to our free Georgia insurance quote page to get your instant, personalized proposal now!

Which Aetna Coverage is Right for Me? is a post from: Georgia Insurance Options

No related posts.

Related posts brought to you by Yet Another Related Posts Plugin.

1. Should you buy health insurance from an agent, or directly from the company?

This one’s easy: use an independent health insurance agent. The rates are the same since they’re set by law, and agents don’t charge any sort of “broker’s fees” or anything to use their service. Agents tend to know a lot more about your options than your average call center employee, and they’ll work with you for the life of your policy.

2. What are the top five health insurance companies in Georgia?

Based on my personal experiences (level of client service, ease of application, claims payment record, etc.), I’d say that the top five individual health insurance companies in Georgia are:

1. Golden Rule (the individual division of United Health Care)
2. Humana
3. Assurant
4. Aetna
5. Kaiser Permanente

Each company has its quirks, of course – Golden Rule is great if you’re in perfect health, but they love to issue riders. Assurant is more expensive, but they are more lenient in their underwriting. Aetna will decline anyone with three prescriptions. Humana doesn’t offer maternity benefits, and Kaiser requires you to stay within Kaiser facilities with most of their plans. Every company is different.

3. Can I still get COBRA if I was fired?

In most cases, yes. There is a provision in the COBRA law that says you are ineligible for COBRA if you were “terminated for gross misconduct,” but that has never been tested in court. Generally, if you leave a company (either voluntarily or involuntarily) and that company stays in business and keeps the group plan that you were on in force, you can get COBRA.

4. Is there such a thing as emergency maternity coverage?

No. If you’re already pregnant, no major medical insurer will issue a policy to you. Now, there are some guaranteed issue policies that will cover you, but you must be extremely careful with those – oftentimes, you’ll either end up paying more for the policy than you would for the pregnancy, or you’ll get stuck with a bill that the insurer will weasel out of. Never purchase a policy like that without consulting with an agent, preferably an independent agent who can compare it with true major medical plans.

5. How do I get my pre-existing conditions covered with an individual health insurance policy?

Depending on the condition, it’s possible that you can just apply for coverage and have it covered. Things like high blood pressure, cholesterol, and most allergies aren’t generally excluded from coverage under individual health insurance policies (however, the rates to cover these conditions may be higher). If you have a more serious condition, like diabetes or Crohn’s Disease, your options are more limited. In Georgia, there’s no state risk pool, so if you’re above the income level for Medicaid then you’re not eligible for state assistance. Your best bet is to find employment with benefits, or, if you’re self employed, talk with an agent about going on a small group plan. That’s a tricky option, but it can be done. There are some guaranteed issue plans in Georgia that will cover pre-existing conditions, but like with question four, you must be extremely careful with those. You can wind up losing a lot of money if you’re not. 

6. What does maternity insurance cover?

Maternity insurance covers the costs associated with a normal pregnancy. Depending on how your specific maternity benefits are structured, you may either have a set amount of money to apply to maternity costs or your maternity costs may apply to a separate deductible. It’s worth noting that true emergency c-sections are covered by your normal health insurance plan.

7. What do I do when my COBRA runs out?

When your COBRA eligibility runs out, you can do one of two things. You can either purchase an individual policy, or you can elect to use a HIPAA conversion option. With HIPAA conversion, the health insurance company that administered your COBRA plan will switch you over to an individual plan, and you can’t be turned down for coverage. HIPAA conversions aren’t available until you have used up your entire COBRA eligibility period.

8. How does my deductible work?

Your deductible is the amount of money in medical costs you’ll be responsible for before your insurance company starts picking up part of the bill. If you have a copay plan, your copays generally will not apply to the deductible. Once you meet your deductible, then (depending on your plan) your insurance company will either pay 100% of the rest of your bills, or you’ll pay a small percentage until you reach your out-of-pocket limit. That small percentage is usually 20%, but some plans do increase that amount.

9. How did the new stimulus package change COBRA?

Previously, if you wanted to go on COBRA then you had to pay 102% of your health insurance premiums. That came as a shock to many people who went on COBRA, because they were used to paying only a portion of the full premium while their employer picked up the rest of the tab. Now, for the first nine months of COBRA eligibility, you’ll only pay 35% of your premiums and your former employer will pick up the other 65% (they’ll be reimbursed in the form of a payroll tax credit). At the end of those nine months, things go back to the way they used to be and you’ll start paying 102%.

10. What’s the best life insurance option for me?

Most people are best served with simple term life insurance. Get a policy that’s guaranteed renewable so that you never have to worry about being uninsurable, a face value that will provide for your loved ones (don’t forget to pay off debt and account for lost income when you’re figuring out how much you should get), and discuss the various riders available with your agent. In my humble opinion, variable life, universal life, and whole life are just not worth it for the vast majority of people. Term is simple, term is easy, and term is what you need. There are a ton of life insurance options out there, and with all the riders available you can really customize your term life insurance to fit your needs.

Bonus!

11. What does “no-stone-unturned” quote mean, anyway?

I get asked this one a lot, so I thought I’d toss it in there. I’m an independent agent, so when you come to me with a health or life insurance question I work with a bunch of different companies to make sure you’re getting the best deal on the market. Instead of just sticking you with an easy-to-issue policy, I leave no stone unturned to make sure that when I run a quote and write an application with you that I’m doing what’s in your best interest. 

Did I miss any burning questions? Anything you’re absolutely dying to know? Then feel free to comment on this post, use the contact link at the top of the page to email me, or just call me up at 404-660-1020 and I’ll be happy to answer any questions you might have. Who knows, your question might make it into the next edition of this article! Or if this cleared up all of your questions and you’re ready to see how much you could be saving on your insurance, then head to our free insurance quote page and get a no-obligation, personalized quote!

Reader’s Choice: Top Ten Health and Life Insurance Questions is a post from: Georgia Insurance Options

No related posts.

Related posts brought to you by Yet Another Related Posts Plugin.

You can find affordable health insurance in the private market!

In fact, let’s repeat that one, because a lot of people find it hard to believe: you can find affordable health insurance in the private market! Just because you’re getting health insurance as an individual instead of part of a group doesn’t mean you have to destroy your bank account every month. The secret is to realize that there’s not one magic bullet that can take health insurance from a giant money sink to just a small portion of your budget, but instead that there are a number of factors that will work together to make your health insurance affordable.

The first thing you should do is look into high deductible health plans. These insurance plans are a lot more simple than most types of health insurance: you have a deductible, and that’s about it. Before your deductible, you’re responsible for your medical costs. After your deductible, your insurance company will pay your bills. Simple! Because these plans don’t include a lot of bells and whistles (either you’re working on meeting your deductible or your insurance company is paying for everything), they’re affordable for the health insurance company – there’s just not a lot of stuff for them to worry about. That means that the savings are passed on to you, making high deductible health plans a very affordable form of health insurance.

If you decide to go with a high deductible health plan, making your health insurance more affordable is pretty simple. Raising your deductible will lower your monthly premiums, and lowering your deductible will raise them. One thing that you should always keep in mind when you’re looking at deductibles is how your particular insurance company defines a “family deductible.” Some companies will assign every family member an individual deductible, some will assign the family as a whole a deductible, and others will give individual deductibles but say that when either two or three family members meet them then the entire family’s deductible is considered met. Your agent will know how each individual company handles family deductibles.

The major thing that people worry about with high deductible health plans is the fact that office visits aren’t covered by a copay. In our dedicated article about HDHP’s we discuss why this isn’t as big an issue as many people think, but if an office visit copay is something you feel like you can’t live without then you still have ways to find affordable health insurance.

The first of these is to ask yourself how many times a year you actually go to the doctor. If it’s only three or four times, but you still really want a copay for those visits, then consider looking at limited copay plans. These plans offer comprehensive benefits and a copay for a certain number of office visits a year (usually two to six). The first few visits are covered by a copay, but after that you’ll be responsible for the full amount of your medical bills until you meet your deductible. Having a limited number of copays a year instead of an unlimited number will make your health insurance significantly more affordable.

The second big thing you can do is to raise your deductible. Having a slightly higher deductible can drastically lower your monthly premiums. This one is pretty self-explanatory: raising your deductible lowers the amount of financial risk the insurance company takes on, saving them money. Those savings are passed on to you in the form of more affordable health insurance.

The last thing is something you should do no matter what: work with an independent agent. There are no “broker’s fees” or anything like that when you work with an agent, so you’ll end up paying the same in premiums that you would going directly to the insurance company. And since independent agents work with several insurance companies, we know who has the best rates and best coverage for various situations. For instance, for the majority of people in Georgia, maybe Carrier A is the most affordable. But perhaps for people in a certain age range Carrier B has better rates, and for people with high blood pressure Carrier C has the most affordable premiums. Your agent, who will have the ability to shop around and work the system in your favor, will be able to find the most affordable health insurance premiums while not sacrificing coverage.

Affordable health insurance is out there, and now you know the easiest way to find it is to use an independent health insurance agent. Luckily, you’ve got an independent agent at your disposal right now! Head on over to our free health insurance quote page and find out just how much you could be saving!

Getting Affordable Health Insurance is a post from: Georgia Insurance Options

No related posts.

Related posts brought to you by Yet Another Related Posts Plugin.

This economy is rough, no doubt about it. Lots of people are suddenly finding themselves laid off, unemployed, and without the group health insurance benefits they had come to rely on. The transition out of the active job market can be rough, and the last thing most people want to think about is finding new private health insurance (not to mention private health insurance that is also affordable health insurance)! Unfortunately, that’s one of the first and most important things you’ll have to worry about.

The first thing to do is to figure out if COBRA health insurance is right for you. Since we’ve discussed how to do that at length in another article, there’s no need to repeat the entire topic here. If you’ve read that article and determined that you need to look for affordable health insurance on your own, then read on.

You’re probably used to group health insurance, but now you’re looking for private health insurance – and those are two very different animals. There are a few key differences between the two types of insurance that you’re going to want to be aware of:

• A private health insurance policy with the same benefits as a group policy will be more expensive than that group coverage. This is unfortunate, but it is a reality of private health insurance. This isn’t to say that private health insurance can’t be affordable, but you should be ready to either pay a little more for the same coverage or investigate a somewhat higher deductible.
• Group insurance is, by law, required to provide certain maternity benefits. Private health insurance is not bound by that same requirement, so maternity benefits aren’t automatically included. Check out our article on how maternity benefits work in the private market for more details.
• If you have any pre-existing medical conditions (you’ve had cancer or open heart surgery in the past, currently have Crohn’s disease, currently have diabetes, etc.), your options for private health insurance are going to be severely limited. In this case, COBRA is probably your best option.

If COBRA isn’t right for you, then your next step is to think about how long you’re likely to be unemployed. If your prospects for employment look good and you think you might be back in the workforce in six months or so, then a short-term health insurance policy might be right for you.

However, if you think it’s going to take more than six months to get back into the workforce, or if you are considering taking advantage of your newfound unemployment to explore the possibility of becoming self-employed, then a normal full-term private health insurance policy will be your better option.

The sudden loss of income that comes with unemployment means that finding an affordable health insurance plan is important to your budget. However, it’s very, very important to remember the following: an affordable health insurance plan can still provide comprehensive benefits. There are cheap health plans that offer limited benefits, leaving gaping holes in your coverage – avoid these at all costs! Remember, that plan that seems too good to be true probably is – the ten bucks a month you can save on your premiums by buying a limited benefit plan will quickly be wiped out when you find out you need surgery or major medical treatment that your limited benefit plan won’t cover.

Now, you’ve learned about the difference between private health insurance and group health insurance, you’ve seen how to determine if COBRA, short-term medical, or full-term health insurance is the best choice for you, and you know that you need to make sure to buy a comprehensive health insurance plan instead of a limited-benefit policy. There’s only one more thing you need to know before you start looking for your new private health insurance plan:

DON’T HESITATE!

When you find yourself suddenly unemployed, you’re working against the clock. If you immediately purchase private health insurance, so long as you don’t have any pre-existing conditions, your new insurance company will see that you just got off of a group plan and won’t have any trouble issuing you a policy. That’s because they know that if one insurance company had you as a client, then you’re probably okay to be a client of theirs, too. However, if you wait too long (about three weeks) to purchase a private health insurance policy, you’ll have what’s known as a “gap in coverage.” When you go that long without health insurance and then go to buy a new private policy, your new insurance company will generally make you pick a policy effective date 30-45 days from the date of your application. That way, they’ll have time to review your medical records and make sure that you’re an “acceptable risk” – a process that can be avoided entirely by not having a gap in coverage in the first place.

Now that you know the most important points about moving from a group to a private health insurance policy, the last step is to contact an independent insurance agent and work with them to find the best policy for your needs. Let that agent know that you’re newly unemployed and that finding an affordable health insurance policy is important to you, but that you don’t want a limited benefit policy. Since independent agents represent many health insurance companies, you’ll have a lot of options open to you. Your agent will know the best ways to narrow them down and help you find the policy that’s right for you!

I know that finding private health insurance when you’re unemployed is a hard thing to think about. It’s easy to feel like everything is piling up on top of you, and it can get a little overwhelming. However, I’m really glad that you’ve taken the time to read this post and learn more about how to protect your family’s health no matter what. The last step is to get your free health insurance quote so that you can find a plan that will protect you, your family, and your bank account. Don’t worry – I’ve been in your situation before, too, and I’ve already learned from my mistakes. But you can protect your family, even when the economy is down – and I can help!

Finding Private Health Insurance When You’re Unemployed is a post from: Georgia Insurance Options

No related posts.

Related posts brought to you by Yet Another Related Posts Plugin.

In 1995, Congress passed the Consolidated Omnibus Budget Reconciliation Act, a law that gives employees the right to continue their group health insurance coverage in the event that they lose their group coverage. Basically, COBRA health insurance allows you to retain your group health insurance in the event that you lose a job with benefits. In other words, it’s a temporary measure to allow you to keep your group coverage until you can find new employment with a new group health plan. There are two big questions to answer when considering COBRA health insurance: how does it work, and it is it right for you?

The first thing you’ll need to figure out is if you’re eligible for COBRA health insurance. There are three criteria used to determine COBRA eligibility:

1. Plan Coverage: to be eligible for COBRA health insurance, you must be coming from a group health insurance plan held by at least twenty employees working more than six months out of the year. So if you worked for a very small group, or if the vast majority of your co-workers were temporary employees, you may not be eligible for COBRA health insurance.
2. Qualifying Event: this is the event that happened to cause you to become unemployed. If you leave your job voluntarily, have your hours reduced to part-time status, or become eligible for Medicare, then you become COBRA eligible. If you leave your job involuntarily (you’re laid off, downsized, or fired) then you’re probably still COBRA eligible. The only way you can be fired and not retain COBRA health insurance eligibility is if you’re fired for “gross misconduct,” but neither the actual text of the COBRA law or any court says precisely what that means. If you lost your job because your company went bankrupt or out of business, then chances are you’re not eligible for COBRA. To be eligible for COBRA, the group you’re coming from must remain in force. So if your former employer goes belly-up or just decides to discontinue group coverage, then you will be unable to elect COBRA.
3. Qualified Beneficiary: You can only go on COBRA health insurance if you were covered by the group health insurance plan the day before the Qualifying Event. If your spouse is the covered individual and you divorce or separate, you may be eligible for COBRA health insurance until you can get on your feet. If your spouse is covered and passes away, you are also eligible for COBRA health insurance.

Once you’ve figured out if you’re eligible, then it’s time for an unfortunate reality check: COBRA health insurance can be extremely expensive. When you have group coverage, your employer pays for a large portion of your monthly premiums (usually at least 75%). However, when you move onto COBRA health insurance, you become responsible for 102% of your premiums. That’s not a typo – you are responsible for the full amount of your health insurance premiums, plus a 2% service charge for administrative costs. COBRA costs can skyrocket quickly, and the sticker shock of the first premium payment can be a very harsh awakening. Your first 102% premium payment will come due 45 days after you first apply for COBRA health insurance. (UPDATE! The recent stimulus package has changed how COBRA payments work. Please see the end of this article for new information)

COBRA health insurance is retroactively effective (meaning, for example, if you get laid off, apply for COBRA, and get approved two weeks later, the effective date of your COBRA health insurance is considered the date of the layoff). This is a great thing, because COBRA is designed to keep you from having a gap in coverage. Not having a gap in coverage means that when you go onto a new group or decide to buy a private health insurance plan you won’t be subjected to a lengthy review of medical records and a series of phone interview – waiting periods that could easily be avoided.

As long as the original group policy stays in force, you can stay on COBRA health insurance for up to eighteen months, although there are a few exceptions. If, for instance, you become disabled during this initial eighteen month period, you can extend the coverage under OBRA (a sister law to COBRA) for an additional eighteen months, bringing your total time of coverage to thirty-six months.

That, in a nutshell, is how COBRA health insurance works. Now, how do you know if it’s right for you?

If you have any sort of significant pre-existing medical condition, then COBRA health insurance is probably a good bet. Things such as diabetes, cancer, or heart disease can make finding private health insurance a nightmare – most private health insurance plans just won’t accept that level of risk. Groups, however, give insurance companies a way of balancing out that risk with a pool of healthy individuals, and so they’re better able to extend comprehensive benefits to people with these conditions. COBRA health insurance is just an extension of your group health insurance, so your benefits under COBRA will probably be better than anything you can find in the individual market. Still, it doesn’t hurt to check – if you just want to know what your options look like with a certain condition, contact me using the link at the top of this and every page and I’ll let you know.

If you don’t have a pre-existing condition, then your best bet is to check out your options in the private market. The private health insurance world is a little different than the world of groups, but I do my best to walk you through it over at this article: Private Health Insurance When You’re Unemployed.

The bottom line is this: COBRA health insurance is fantastic if you’ve just lost your job with benefits and you need health insurance for a pre-existing medical condition. However, if you’re generally in good health, chances are your options in the private health insurance market are going to be better than what you could find with COBRA health insurance.

If you have any questions or concerns about COBRA health insurance, please use the contact link at the top of this page to send me an email and I’ll do anything I can to help. If your needs are more urgent, or if you just want to hear my happy voice, then feel free to call me at 404-660-1020, anytime!

UPDATE: COBRA UNDER THE NEW STIMULUS PACKAGE

Since the recent stimulus package passed, the way COBRA is funded has changed dramatically. Now, if you’ve lost your job between September 1, 2008 and December 31, 2009 and are eligible for COBRA health insurance, you’re only on the hook for 35% of the costs of your health insurance instead of 102%. The other 65% is still paid for by your employer, who is reimbursed in the form of payroll tax credits. This subsidy is available for the first nine months of eligibility, so after that things go back to the 102% mark.

The COBRA subsidy applies to group health insurance plans, as well as group dental, vision, and HSAs. FSAs are excluded from the subsidy.

This means COBRA coverage can be more affordable for folks using it as a temporary form of health insurance while between jobs. COBRA is still not a long-term solution, and it’s still a very good idea to compare the quality and cost of reduced-cost COBRA coverage with private health insurance plans.

For an official rundown of the COBRA changes, have a look at this extremely comprehensive look at the COBRA changes. If you have any questions that neither this article nor that page can answer, please feel free to contact me and I’ll help you in any way I can.

Is COBRA Health Insurance Right For You? is a post from: Georgia Insurance Options

No related posts.

Related posts brought to you by Yet Another Related Posts Plugin.

If you look around this website, you’ll find pages and pages of information about how wonderful it is to use an independent agent, how having an expert on your side can save you time and money when dealing with health insurance companies, and how having your own, personal agent on call to address your insurance needs can truly save you. But, there is one downside to using an independent insurance agent: we’ve got access to hundreds of different policies.

Now usually that’s a good thing. It means that you have a great deal of choice, that you’re not tied down to any one company or product line, and that your agent can just about always find a policy that offers the right combination of protection and monthly cost for your needs. However, that amount of choice can also get a little overwhelming and can make the task of narrowing things down to just one plan seem slightly daunting. Imagine walking onto the lot at a Carmax and just telling a salesman “I want a car.” He’d probably look at you blankly and have no idea where to get started, right? Even though that car salesman knows where everything is on the lot and knows the details and specs for all of his cars, he still needs you to let him know a little about what you want in order to help you find the right vehicle for you. So you go to the dealership armed with a little information, like how many passengers you want to be able to seat, what color you want, what kind of interior, and so on and so forth. Health insurance works in a very similar way – there are hundreds of plans out there, and the benefits are very different with all of them. Some cover well-care for children, while some have excellent accident benefits. Some have better copay structures, while some have an awesome health savings account component. If you know a little bit about what you want, you and your agent can work together much more effectively to find the policy that will work best for you.

So, how do you do that? How do you go about figuring out what type of policy is best for you and your family? You don’t have to have all of the answers, of course, since you’ll be working closely with an independent agent and he’ll be able to help you figure that out, but like we discussed a moment ago, it’s a good plan to have a basic idea of what your needs regarding health insurance will be.

In my experience, the best way to get started is to ask yourself three questions:

1. What do I like about your current policy?
2. What don’t I like about your current policy?
3. If I could design a policy from the ground up for yourself, what would you put in it?

Answering these three questions will just about always point you towards the right policy for you. There are a few things to keep in mind when you’re asking yourself these things.

When you’re thinking about what you like about your current health insurance plan, think about the past few times you’ve had to use it. Have you been to the doctor’s office or emergency room lately? Did you have a copay for either visit? Have you had to call your insurance company recently, and if so, were you satisfied with the level of customer service you received? What kind of deductible do you have now? How are your prescription drugs handled?

Thinking about these things will also probably reveal what you don’t like about your current plan. Maybe your current deductible is too high, or your prescriptions aren’t covered like you want them to be. Maybe you don’t have a copay and you want one – or maybe you do have a copay, but you never use it and want to lower your premiums by doing away with it.

When you get through thinking about what you like and don’t like about your current insurance policy, you should have a decent idea about how you feel about your deductible, your copay, and your premiums. Additionally, if you’ve had to use your health insurance lately, you’ll probably have an idea about any special circumstances you want your policy to cover (for instance, if chiropractic care is covered, if wellness benefits are included, and so on).

Now with that information, you’re ready to tackle the third question: if you could design a policy from the ground up, what would you put in it? This is where you get to make sure any special considerations you may have are taken care of. For example, do you want to make sure that your child under age five will have free well-care checkups? Do you want to make sure a certain prescription drug is covered? Do you want to have extra coverage if you have some kind of accident (known as a supplemental accident benefit)?

The next step is to take this idealized plan you’ve built and give it an unfortunate “reality check.” Personally, I want a health insurance plan that has a $10/year deductible, covers all of my office visits with a $2 copay, gives me free prescription drugs whenever they’re prescribed, sends me Chinese food on Fridays, and does it all for under $5 a month. That plan, however, doesn’t exist, which means you’ll need to identify which category you have more flexibility in: are you more willing to let your premiums go up a little to get the coverage you want, or do you want to increase your deductible and maybe eliminate your copay to get down to the monthly premiums you can afford?

Think about this: the difference between a $1500 and a $2500 deductible is $1000 a year, but if you save $84 a month by moving to a higher deductible, then you’ll have made up that difference just from your premium savings. That means you have that money in your pocket instead of sending it to the insurance company – and believe me, if you don’t meet that $1500 deductible, they’re not going to send any of your money back for “overpaying” them. Raising your deductible can put extra money in your pocket while still giving you comprehensive coverage, and is probably the area you should look at when you’re trying to figure out how to fit health insurance into your monthly budget.

Now, you’ve identified what you like about your current policy, what you don’t, and what you would change. On top of that, you’ve figured out what sort of deductible you’d like to look at, if you want an office visit copay, and any special things you want included in your new health insurance policy. Furthermore, you’ve figured where you can be flexible if you have to be: benefits, or premiums. The only thing that’s left is to sit down and start looking at policies until you find one that matches what you want.

Everything up to now has sounded harder than it really is. Unfortunately, this last part flips that on its head by sounding significantly easier than it is. There’s much more to the final step than writing down a deductible, copay, and premium amount and just looking at plans until one matches up. This is where your independent agent comes in. With access to hundreds of different policies, that choice that earlier looked overwhelming now just looks welcoming.

With the knowledge you’ve gained from reading and applying the techniques outlined in this article, you and your independent agent are now ready to sit down and figure out the exact policy that will work best for you. And remember, working with your independent agent to select your personal health insurance policy isn’t just a one-time interaction – you’ll be getting an expert on your side who will work for you for the life of your policy. But you’ve already read the article about Why You Should Use an Independent Agent, right?

When you’re ready to start working with your own independent agent, visit our free Georgia insurance quote center. You’ll be shocked at how easy it is to work with an independent insurance agent, and even more shocked at how affordable insurance can be!

How To Choose The Right Health Insurance Policy is a post from: Georgia Insurance Options

No related posts.

Related posts brought to you by Yet Another Related Posts Plugin.

1. What’s the deductible?

This should be the first question you ask about any policy. The deductible is the amount of money that must come out of your pocket before your health insurance company will begin paying benefits. So, if you have a $500 deductible, and you get a $750 hospital bill, then your benefits will kick in on the last $250. That first $500 will be applied to your deductible.

Your deductible will have a massive impact on your health insurance premiums. Having a higher deductible will lower your premiums, and having a lower deductible will raise them.

Take care to note, however, that that doesn’t mean you’ll only have to pay $500 dollars and consider that $250 handled. Many health insurance plans have a coinsurance amount linked to an out-of-pocket limit. In fact…

2. What’s my coinsurance and out-of-pocket?

Depending on the company, the “out-of-pocket” limit may also be called a “stop-loss” or “break point,” but these things are all the same. Your out-of-pocket limit is the amount of money beyond your deductible that you’ll be responsible for before your plan pays 100% of your remaining medical costs. The out-of-pocket limit is always paired with a coinsurance amount, which defines what percentage of costs beyond your deductible you’ll be responsible for on any given bill. So for instance, if you’ve satisfied your deductible but have a $1000 out-of-pocket limit with an 80% coinsurance, and you get a bill for $100 dollars:

• The insurance company will pay $80 of this bill
• You’ll be responsible for $20 of this bill
• And that $20 will be applied to your out-of-pocket limit, reducing the balance down to $980.

So, even though the bill was $100 dollars, you were only responsible for $20 because you had met your deductible. With these numbers, if you had medical bills (after your deductible) totalling $5000, you would be responsible for $1000 and the insurance company would pay the remaining $4000. Paying that $1000 would also cause you to reach your out-of-pocket limit, so any additional covered medical bills within your beneift period would be covered at 100%. Out-of-pocket limits are generally locked into various policies, so even if your agent can adjust the deductible it’s common that the out-of-pocket can’t be changed.

One important thing to note is that if you have a high deductible health plan, or HDHP, you usually won’t have an out-of-pocket limit. Once you meet your deductible, your costs will generally be covered at 100%.

3. Is the deductible per-incident, per-confinement, or per-year?

This one is huge. One of the sneakiest ways health insurance companies reduce their risk, and therefore lower their costs and raise their profits, is by defining their deductibles by confinement or incident instead of the standard per-year definition. With most health insurance policies, once you meet your deductible, you’ve met it for the year. Any further medical bills will be applied to your out-of-pocket limit, and then covered at 100% once that is satisfied. This means that if you have more than one incident in a year that causes you to incur significant medical costs, you’ll be covered.

However, if you have per-confinement or per-incident deductibles, things are very, very different.

With per-confinement or per-incident deductibles, every time you have a situation where you require medical attention is subjected to its own deductible. So if you have a $1000 per confinement deductible then have food poisoning in January, a broken arm in March, strep throat in June, a routine OBGYN visit in August, a case of the sniffles in October, and you cut your hand open carving the Thanksgiving turkey, then each one of these incidents is subjected to its own $1000 deductible!! In other words, say the total medical bills related to your food poisoning come out to $800, your broken arm is $750, the two doctor’s office visits together come out to $350, and then the ER visit for the Thanksgiving mishap comes out to $500. That totals up to $2400 in medical bills for the year, which means that $1000 should apply to the deductible and $1400 to the out-of-pocket limit, right? Nope — you’ve got per-incident deductibles, and not a single one of those visits cost more than $1000. That means that with each new medical incident your deductible reset back to $1000, and you never once met it. Every last dollar of those medical bills comes out of your pocket, because the deductible was per-incident, not per-year.

Long story short, deductibles should be per year, not per incident or per confinement, especially if you have more than one person on the policy. MEGA Life and Health is infamous for defining its deductibles by incident instead of by year. Golden Rule’s short-term medical plans also use per-incident deductibles, which is why they’re one of the cheapest short-term medical policies on the market.

4. Do I have an office visit copay?

When you go to the doctor, some insurance plans hold you responsible for the entire sum of the bill (subject to your deductible and coinsurance, of course) while others employ a copay. Basically, when you have a copay, you’re responsible only for a nominal fee to go see your doctor instead of the full bill. That fee usually hovers around $15-$35 for a primary care physician (a family doctor) and $25-$55 for a specialist (an orthopaedic doctor, dermatologist, OBGYN, or other, specialized doctor).

On the face of things, a copay sounds fantastic. Instead of being responsible for the entire cost of a doctor’s office visit, a copay reduces the cost to a predictable amount that is essentially always lower than the full bill. However, adding a copay to your insurance plan is the number two biggest thing you can do to increase your monthly premiums (number one is lowering your deductible). Think about this: how many times a year do you go to the doctor? Most people will say anywhere from one to three visits is average for them. The additional cost you would pay upfront for those one to three visits a year is almost always offset by the amount of money you’ll save off of your monthly premiums by switching to a plan that doesn’t offer an office visit copay. Let’s run the numbers:

• The average cost of a primary care visit is $60; a specialist visit averages about $175
• The average primary care copay is about $35; for a specialist, that’s about $50

So in a year that you went to your primary care doctor twice and a specialist once, you’d pay $120 on a copay plan or $295 for a plan that doesn’t offer copays. The difference there is $175, or a little under $15 a month. In this scenario, it makes sense that if you can save over $15 a month by eliminating copays from your plan, then it’s smarter to be without copays than to include them. I can say with a great deal of confidence that if two plans are identical in every way except that one offers a copay and one doesn’t, then the plan without a copay will always offer savings greater than $15/month in premiums.

If you’re really, really tied to having a copay, then consider asking your agent about a plan with a limited number of office visits covered by copays a year. Most limited-copay plans give you six or so office visits a year covered by a copay, and you’ll be responsible for the full bill after those visits until you meet your deductible. These plans give you a compromise by lowering your premiums but still giving you the comfort of the copay.

5. Do I have a limited period to get diagnostic tests?

After the per-confinement deductible, this is the worst trick an insurance company can pull. With most plans, diagnostic tests can be done at any time so long as they’re medically necessary. This means that if you think you’ve broken your hand, you go to the doctor, have an x-ray, and then find out that you’ve just bruised it, well, no big deal. That x-ray was deemed medically necessary by your doctor, and therefore it was a covered expense.

This changes, however, with some types of health insurance plans. Certain plans allow diagnostics only in a certain time period before and after a surgical procedure or inpatient confinement. For instance, some MEGA Life and Health plans allow diagnostics only fourteen days before and/or fourteen days after a surgery or inpatient confinement. This means that, in our example above, the x-ray would not have been a covered expense because no surgery resulted from it.

That limited window for diagnostics can be a minor pain when dealing with things like hand x-rays, but it can be absolutely devastating when dealing with monitoring a long-term condition like leukemia, or monitoring recovery after major surgery. You have health insurance to cover medical costs, so why would you accept a plan with such a fundamental limitation?

These five questions will give you a great deal of information about your plan by covering the basics (copay, out-of-pocket, and deductible) and will make sure you catch it if the policy includes one of the two most common sneaky limitations (per-confinement deductibles and diagnostic windows) that insurance companies use to limit your benefits. When I sit down with a client, these are always the first five things we go over, because I know that these five points are the most important things they could ask me to make sure they’re getting the level of coverage that they need.

There’s one question that’s not on the list, because it’s the one everyone already knows to ask: what’s the cost? Well, the easiest and safest way to figure that out is to head up to our free Georgia insurance quote page and get a free, no-obligation, no-stone-unturned insurance quote. You’ll be amazed at how easy insurance can be when you work with an independent agent, and shocked at how affordable insurance can be when you have an expert in your corner!

Top Five Questions For Your Health Insurance Agent is a post from: Georgia Insurance Options

No related posts.

Related posts brought to you by Yet Another Related Posts Plugin.

“I can’t afford health insurance!”

I can’t tell you how many times I heard that when I used to work in a doctor’s office as an insurance benefits specialist. Know what else I can’t tell you? How many people walked out of our doors followed by phone calls, letters, and eventually collections agents and bankruptcy attorneys. What these people truly couldn’t afford was to not have health insurance.

The cost of health care can be astronomical. Accidents happen, critical illness strike, and they generally don’t have the manners to call a week ahead of time to let you know they’ll be visiting. Are you one of the people who says they don’t have health insurance because they can’t afford it – but hey, it’s not like you plan on getting sick anytime soon, right?

Stop reading this article right now. Get in your car, go to the nearest hospital emergency room, and ask how many people there were planning on getting sick. Ask how many of them were planning on having an accident that day. See the guy with the appendix that’s about to rupture? He’ll be getting a bill for over ten thousand dollars in the mail before too long. The kid in the corner who fell off of his bike and whose parents don’t have health insurance coverage? That broken arm is going to cost at least a hundred bucks to evaluate, plus another $175 per x-ray (and they’ll probably do two or three), plus casting fees (triple the cost if the doctor deems a waterproof cast necessary), plus follow-up visits (at least one, at at least $125), plus cast removal (another $150 or more), plus physical therapy if he needs it. The thirty-five year old guy who didn’t realize he had an almost complete arterial blockage until he had a heart attack – forget it. If he survives, he’s bankrupt. If he doesn’t make it, his family will be.

If your budget is truly so tight that you don’t think you can afford health insurance, then take a close look at where your money is going. Ask yourself this: what is going to truly ruin our family, an extra set, steady charge each month that we can plan and budget for, or a sudden crush of medical bills?

I can’t emphasize this enough. You should be looking to save money on the cost of your health care, not your health insurance. Sure, you can adjust your deductible and coinsurance levels. You can eliminate a copay from your plan, like we talked about in another article. But you simply cannot afford to go without health insurance – it’s a gamble, and it’s one that may work for a while, but it’ll get you in the end. The bottom line is this: no matter your situation, you need health insurance. If you’re self employed or own your own business, the costs of a medical emergency can cripple your financial infrastructure and run your business into the ground. If you have a family, you owe it to your children and your spouse to protect them from financial devastation. Even if it’s just you, modern day hero, a healthy young man or woman going it alone, bankruptcy can ground your dreams and take years to claw your way out of. You don’t go broke because you have a monthly premium to pay. You don’t go broke because you’ve factored a set, predictable monthly cost into your budget. If you go broke, it’s going to be because you got slammed with a hundred thousand dollar medical bill and don’t have insurance coverage that will pay for it.

The reason many people think they can’t afford insurance is because they think health insurance is an all-or-nothing proposition. Either you get the $750 a month policy that covers absolutely everything at no cost past premiums or it’s just not worth paying for. This simply isn’t the case. Now, don’t get me wrong; if you have room in your budget for the high-end policy and you, with the counsel of your local independent agent, decide that that’s the level of coverage you need, then that’s what you should buy. But for the vast majority of people, a policy that robust simply isn’t necessary. What’s the point of paying for coverage you simply don’t need? Think about it this way: what’s the point of buying a Hummer with Swarovski crystal rims and velvet airbags when all you want to do is drive to McDonalds?

The reality is, you probably don’t need a plan that has a $10 co-pay for all services with no deductible, no out-of-pocket cost, and 100% coverage. The reality is, you can probably get the coverage you need at a lower price than you think! Your local independent agent will know what plans offer the proper level of coverage while still bringing an affordable price to the table. The fact is, no matter what your budget, there’s a health plan out there that will work for you. Think about your car insurance. It covers you in the event of an accident, right? Do you have car insurance for that day you have an accident, or do you have car insurance to cover your oil changes, new wiper blades, air in the tires, and the occasional wash? Can you imagine how much more expensive your car insurance would be if it covered those things? Health insurance works the same way! Eliminate the benefits you don’t need, put the money you save on premiums away, improve your financial situation, enjoy the peace of mind that comes with comprehensive coverage, and everybody wins.

Save money on the cost of health care, not by eliminating health insurance from your budget. It’s a gamble that you, your business, and your loved ones will pay for when – not if – you lose. Georgia Insurance Options is 100% dedicated to getting you the coverage you need at the price you can afford, so when you’re ready to protect your family head on over to our free Georgia insurance quote page and get your personalized health insurance proposal today.

The Unaffordable Health Insurance Myth is a post from: Georgia Insurance Options

No related posts.

Related posts brought to you by Yet Another Related Posts Plugin.

We all know that health insurance is important – without it, we’re open to an unacceptable level of risk from unforeseeable, unavoidable health problems. But we know too that sometimes it can be tough to fit health insurance into our budgets. Trust me, I know – long ago, my family thought that we were spending a little too much money each month and thought it might be a good idea to save by cancelling our family health insurance policy. Well, after a while, my parents realized that perhaps this wasn’t the best idea – my mother hasn’t ever been the gambling sort, and she was worrying constantly about what might happen if one of us got sick without coverage. So my parents sat back down and decided that we’d just skip eating out a few times a month, maybe give up some of the premium channels in our cable package, and perhaps I didn’t really need to be taken to Toys R Us quite so often (I realize now that they made the right decision, but there’s no way you could have convinced me of that then!).

That was probably about fifteen or sixteen years ago. Since then, my parents’ combined medical bills have totaled in the millions of dollars. A fourteen year battle with Ménière’s Disease for my mother and a failed struggle with cancer for my father meant the bills rolled in fast and hard – and we didn’t see the onset of either one coming. Looking back now, I almost have to laugh. The amount we’ve paid in premiums is negligible compared to what the cost of her streptomycin injections and brain surgery would have been out-of-pocket. Paying for health insurance instead of HBO doesn’t seem like such a sacrifice when I realize it bought me a few extra weeks with my dad. The point is, I know it can be tough to find room in the monthly budget for health insurance coverage – but it can frequently be absolutely impossible to find room for those medical bills once they hit you.

We’ve used this example in another article, but it’s a good one that bears repeating. What do you use your car insurance for: to cover your expenses in the event of a wreck, or to cover the expenses associated with oil changes, new windshield wipers, fresh air filters, and a wash and wax every weekend? Of course, your car insurance is there to cover the big things – not the little tiny things like the ones we just listed. But if your car insurance did cover those little things, can you imagine how expensive your premiums would be?

Health insurance works the same way! If you want your health insurance to cover every bump and scrape, then your premiums are going to be higher. If, however, you are willing to take responsibility for some of the minor costs of your medical care, then your premiums are going to be much, much lower. There’s a way to do this, and it’s called a High Deductible Health Plan. Remember the story I told you at the beginning of this article about my own life experiences with the health care industry from the consumer’s perspective? Those bills didn’t come from check-ins with our pediatrician, or from a case of the sniffles. They came from surgeries, tests, and esoteric procedures – and those are the crucial risks you can’t afford to not be protected from.

A High Deductible Health Plan, or HDHP, is defined as any health insurance plan with a single-person deductible of $1100 or more (or a family deductible of $2200 or more) and a maximum out-of-pocket limit of $5600 or more (or a family out-of-pocket maximum of $11200). Usually, however, a HDHP is set up with a straight deductible around $2500 to $5000. You are responsible for your medical costs up to that point – after that, you’re covered at 100% of allowable charges.

What does this mean? Well, first off, it means your premiums are lower. Since you’re assuming more responsibility for the little costs of your personal healthcare, the insurance company doesn’t need to take as much money in the form of premiums to cover that risk.

Secondly, it means that your insurance is covering the things you truly need. If you have a cold, sure, you’re going to have to pay for that visit to the doctor out of your own pocket. The average visit to a primary care physician costs about $60, not including any labs or diagnostics that might need to be done. Think about it though, how many times in the past year have you gone to the doctor? Say you went three times, and each visit cost you that $60 – that’s $180 in doctor’s office charges for the year. So for the year, you’ve spent the same as $15 every month ($15 a month X 12 months = $180). But if you’ve saved $30 a month by switching to a high deductible health plan, then you’re still ahead of the game! Not only that, but you’ve still got quality insurance to protect your assets in the event something happened.

Now, keep in mind, we’re not talking about limited benefit plans. A high deductible health plan isn’t a plan that has a ton of limitations, riders, exclusions, and confusing clauses. The premiums for a HDHP aren’t lower because the plan doesn’t cover cancer, or won’t pay on claims related to high blood pressure – if it’s a covered expense under one of the $1000 a month policies, then it’s a covered expense under a HDHP. The only difference is that you have to meet a higher deductible before your benefits kick in and, usually, that you won’t have a copay for your smaller health care concerns.

There’s one more thing about high deductible health plans that makes them an excellent solution for your health insurance needs: HDHP’s are the only type of plan qualified for health savings accounts.

A health savings account is a tax-advantaged medical savings account. Any money you place into your health savings account is not subject to federal income tax and can be used for qualified medical expenses at any time without federal tax liability. In other words, if you put money into a health savings account and then pay for a qualified medical expense with funds from that health savings account, then that money is never subjected to federal income tax. You can put up to $3000 a year (for an individual policy, or $5950 a year for a family policy) into your health savings account, and those funds roll over year after year after year. So long as you have a HDHP, you can keep depositing money into your health savings account up to the annual contribution limit. If you cancel your HDHP and move to a plan that doesn’t qualify for a health savings account, you don’t lose your money – you can keep taking it out until the account is depleted, but you can’t put any more in. Furthermore, you can take the money in your health savings account at any time even for non-medical expenses, but the funds you withdraw become subject to income taxation and you incur a 10% penalty.

So basically, with a high deductible health plan, you get the same coverage, a lower premium, qualify for a tax-advantaged health savings account, and have more control over your health care dollars. Sound like a good deal?

High deductible health plans are the hottest product in health insurance these days, and it couldn’t be easier to start saving money with one each and every month. Head over to our free Georgia insurance quote page and find out just how much you’re overpaying now and how to put that money in your pocket, not an insurance company’s!

High Deductible Health Plans is a post from: Georgia Insurance Options

No related posts.

Related posts brought to you by Yet Another Related Posts Plugin.

Health insurance can be a complicated thing to figure out alone. A lot of questions immediately spring to mind when looking at health insurance policies. What’s a premium and how are they paid? What’s a copay? How does my deductible work? What do you mean “coinsurance?” In this article, we’re going to go over the basics of individual health insurance policies and try to clear up some common misconceptions. After reading this, you’ll be a more informed consumer and better equipped to select a health insurance policy appropriate for your needs!

First things first, what is health insurance and why do you need it? This question’s simple. Health insurance is a type of insurance that protects you against the costs of medical care – and believe me, medical care can be expensive! Take a look at a few real-life claims and imagine how different the patient’s situation might have been without the coverage provided by their medical insurance (for reference, these claims were paid by Assurant Health). When you see “cost to patient” below, that cost generally represents the patient’s deductible and coinsurance. Don’t worry, we’ll cover exactly what these terms mean soon!

• 38 year old male, heart attack
  • Cost to patient: $3500
  • Amount paid by insurance company: $92,729.87
• 18 year old female, multiple injuries resulting from motor vehicle accident
  • Cost to patient: $550
  • Amount paid by insurance company: $165,818.16
• 13 year old male, leg broken in bicycle accident
  • Cost to patient: $5500
  • Amount paid by insurance company: $337,404.68
• 33 year old male, complications from prescription medication
  • Cost to patient: $3,838.98
  • Amount paid by insurance company: $1,467,700.55

Now, it’s obvious that having health insurance protected these people from HUGE medical bills that might have otherwise had a severely negative impact on their financial well being. You may read those claims and think to yourself “But I thought they had health insurance! They pay their premiums for coverage – why did they have to pay anything at all?” This is where several very important elements of any health insurance plan come in: the premium, the co-pay, the deductible, out-of-pocket limit and the coinsurance. Let’s go over these one by one.

Many plans include a copay, which is most easily explained as a small, set dollar amount that covers certain medical services. For instance, if your plan has a $20 copay for a primary care physician’s office visit, then a trip to your family doctor will cost you $20 out of pocket and the insurance company will pay the remaining balance for the visit. Plans with copays generally offer them for doctor’s office visits, prescription drugs, emergency room visits, and sometimes visits to outpatient surgical centers. It’s very important to make sure you know exactly what services are covered by your insurance copay before you solicit or agree to services provided by medical practitioners. Some copays include all services that can be included during the course of an office visit, while others may only cover the physician’s evaluation – any diagnostic tests, applications of casts, injections, or other miscellaneous services might not be covered. If you have questions as to what your policy covers, contact your health insurance agent. Your agent should be familiar with your individual policy and will be able to review your policy with you and answer any questions you might have.

A deductible is the amount of money that you, the patient, are 100% responsible for before your insurance plan will pay anything beyond what is outlined in your copay agreement. If your plan has a $1000 deductible, you will have to pay one thousand dollars towards the cost of your medical care before your plan begins to pay any benefits. As a general rule, the higher the deductible is on a policy, the lower the premiums. This is because the insurance company assumes less of the financial risk of your policy and you assume more financial risk. Once your deductible is met (meaning you have paid, in this example, $1000 towards your medical care), your benefits begin to kick in.

However, just because you’ve met your deductible doesn’t automatically mean that your insurance plan will cover the rest of your medical bills in full. Most plans have what’s known as an out-of-pocket limit (this is sometimes also called a stop-loss or break point – these terms all mean the same thing). This limit is the maximum amount you’ll be required to pay for any given benefit period – the maximum amount of money that will come “out of your pocket.” If you’re responsible for 100% of your medical costs up to your deductible, and the insurance company is responsible for 100% of your costs over your out-of-pocket limit – but what about in between, above your deductible but below your out-of-pocket limit? This is where coinsurance comes in. Say you have a 20% coinsurance on your policy – you will be responsible for 20% of the cost of your bill and the insurance company will be responsible for 80% of your bill until you have paid enough money out of your own pocket that your out-of-pocket limit is reached.

This is just the beginning – health insurance can be very complicated, and having your own independent agent on your side can help you navigate these tricky waters. In the following articles, we’ll delve a little deeper into the nuances of health insurance. In the meantime, there’s no need to wait to save on your monthly health insurance premiums. Visit our free Georgia insurance quote page to get your personalized health insurance proposal today and see just how much money you could be saving!

Health Insurance 101 is a post from: Georgia Insurance Options

No related posts.

Related posts brought to you by Yet Another Related Posts Plugin.