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

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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

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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

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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

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