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Help Center
What is a deductible
Health Insurance plans almost always have a deductible, which is a fixed amount that you as the policyholder are responsible for paying before your health insurance plan covers the remaining costs. For example, if you have a medical bill for $10,000, you may be required to pay the first $500 before your health insurance company pays the remaining $9,500.
When looking for a good health insurance policy, it is important to keep in mind that health care plans with a higher deductible will likely have a lower monthly premium, and vice versa. In addition, it is wise to identify the medical services that are covered without having to pay toward your deductible for your health insurance policy.
What is a Co-Payment?
Health Insurance Plans often have co-payments, which are fixed amounts that you as the policyholder are required to pay for a specific medical service. For example, your individual health insurance policy may require you to pay $20 every time you visit a doctor.
What is Co-Insurance?
Low cost health insurance plans often have Co-Insurance, which is the amount that you as the policyholder are required to pay for medical services after the deductible is met. This amount is usually a percentage. For example, your health insurance company may require you to pay 10% of the total hospital bill for a routine surgery.
What is a provider network?
Some of the best health insurance plans have a provider network, which is a group of doctors, hospitals, and specialists who provide services to members of the network for a discounted price. HMO’s often have a provider network, which is why they are able to offer lower monthly premiums. If you purchase an affordable health insurance plan with a provider network, you must visit doctors and hospitals that participate in the network in order to receive benefits.
What is an out-of-pocket maximum?
Health insurance plans normally have an out-of-pocket maximum, which is the maximum amount you will have to pay for the year before your health insurance plan picks up the remaining costs for medical services. Most health insurance plans cap your out-of-pocket maximum at a few thousand dollars, which is important as it limits your financial risk if you have an unfortunate catastrophic event.
What is a Lifetime Maximum?
Health insurance plans will have a “lifetime maximum”, which is the total amount your health insurance plan will pay for the entire duration of your coverage. Once you as the policyholder reach your lifetime maximum, your plan will no longer pay for Medical services. Try to choose a health care plan with a high lifetime maximum, just to play it safe.
What is a waiting period?
Health insurance policies will sometimes have a waiting period, which is the amount of time after your policy is issued that you as the policyholder must wait before the insurance company will pay for medical services. For example, if you purchase a health insurance plan that has a ten day waiting period and it is issued on June 1st, you will have to wait until June 11th before the health insurance plan will pay for medical services.
What is a rate-up?
Health insurance rates will sometimes have a “rate-up”, which is an increase in the monthly premium that an insurance carrier may require because of pre-existing health conditions or your medical history. If necessary, this amount will be assessed after your health insurance application goes through underwriting.
Health Maintenance Organization (HMO)
A very popular type of health insurance plan is the HMO, or Health Maintenance Organization. An HMO plan will typically offer lower out-of-pocket costs for consumers, but will also limit your ability to choose doctors, hospitals, and specialists with whom you feel most comfortable. When participating in this type of affordable health insurance plan, you will be required to choose a Primary Care Physician who you will consult for all medical services. If necessary, your primary care physician will refer you to a specialist in the network for specific medical issues. It is important to remember you will not receive coverage for doctors, hospitals, or specialists that do not participate in the “network”.
Preferred Provider Organization (PPO)
Our preferred health insurance plan is the PPO, or Preferred Provider Organization. A PPO plan is a very popular choice as it combines the benefits of an HMO and an indemnity plan. These affordable health insurance plans contract Doctors, Hospitals, and Specialists to participate in their network and they encourage you to see these providers for medical services. However, you have the freedom to visit any doctor, hospital, or specialist who you feel will provide the best healthcare.
The network enables these health insurance plans to cut costs, which they can pass on to you as the policyholder in the form of lower monthly premiums. However, they also offer increased flexibility which many people find invaluable.
What is an Indemnity Plan?
An indemnity plan is a type of health insurance that offers the policyholder the freedom to choose which doctors, hospitals, and specialists he would like to visit. However, there may be higher out-of-pocket costs and the application process can be difficult. With this type of health insurance plan, you will not be required to choose a Primary Care Physician and there is never any need to receive a referral to see a specialist.
An indemnity plan will likely have a sizable deductible and will usually pay your claims at a set percentage of the “usual, customary, and reasonable rate” (UCR) after the deductible is met. The UCR rate will be determined by how much the healthcare providers charge for services in your area. In addition, these health insurance plans may require you to pay for medical services up front and then submit a claim to the insurance company for reimbursement.
What is a Point-of-Service Plan?
A great health insurance option is the Point-of-Service Plan (POS), which combines characteristics of both HMO and PPO plans. Members of these health insurance plans are required to choose a Primary Care Physician (PCP) and will be encouraged to receive medical services from providers who participate in their network. Services received within the plan network will typically not have a deductible and will almost always have lower out-of-pocket expenses (co-payments and co-insurance). Members of these health insurance plans do have the option of receiving care outside of the network, but will likely have to pay a deductible and higher co-payments.
What is an HSA?
A great compliment to a high deductible health insurance plan is the HSA, also known as a Health Savings Account. The HSA is a very popular optio for people who prefer to self-insure. These accounts have preferential tax treatment and may be used in conjunction with an HSA-eligible high deductible health insurance plan. High deductible health insurance plans tend to be less expensive then lower deductible health insurance plans so participants who choose this option may lower their monthly out-of-pocket expenses. In addition, contributions to Health Savings Accounts are made pre-tax (up to defined annual limits) and may be invested as you see fit. The money in these accounts will accrue interest tax free, but the funds may only be used to pay for qualified medical expenses.
Frequently Asked Questions (FAQs)
What Products do you Offer?
- Individual Health Insurance
- Family Health Insurance
- Medicare Supplement Insurance
- Group Health Insurance for Small Business
- Health Savings Accounts (HSA)
What does health insurance cover?
Health Insurance Plans usually cover doctor visits, outpatient surgery, hospital visits, emergency room care, lab tests, prescription drugs, skilled nursing care, physical therapy, and occupational therapy. Common health insurance plan exclusions include glasses or contact lenses, physical therapy, rehabilitation for substance abuse, fertility treatment, and cosmetic surgery.
What if I have a pre-existing medical condition?
If you have a pre-existing medical condition, the health insurance plan you purchase may have additional exclusions, which will be outlined in a separate document attached to the health insurance plan description you receive after you have enrolled. These exclusions are usually in effect for a defined waiting period, which can be as long as one year.
Will I have to change doctors with a new health insurance plan?
If you purchase a health insurance plan that has a “network”, you should make sure that your existing healthcare providers participate in the plan network for the insurance carrier you are considering. Most major insurance carriers have large networks and it is highly likely your current doctor and hospital participate in one of these networks. However, If your doctor or hospital does not participate in the “network” you may have to find a new one in order to receive care. However, if you enroll in a PPO you will have the freedom to choose any doctor, hospital, or specialist you like. It is important to keep in mind you may have higher out-of-pocket costs for providers who do not participate in the “network”. Some doctors and specialists are worth it!
How can I find the most affordable health insurance plan?
The prices for all health insurance plans are regulated by the state, which means every agent, broker and insurance carrier must sell these plans for exactly the same price. The trick to purchasing an affordable health insurance plan is understanding the relationship between deductibles, co-payments, and co-insurance. Most low cost health insurance plans with high deductibles will have lower monthly premiums, while health insurance plans with low deductibles will often have high monthly premiums. In addition it is important to consider how much you are willing to pay for co-insurance or co-payments each time you visit your hospital or doctor as these choices will directly affect your out-of-pocket expenses. Most people prefer to enroll in PPO health insurance plans to save as much money as possible while still having the freedom to choose a great specialist if needed.