If you are in relatively good health, the main purpose for health insurance is to protect your assets and give you access to care. If something crazy comes along, it’s easy to run up a bill that is well into the hundreds of thousands of dollars…or even much higher. This is the main purpose of insurance – it protects your assets and prevents you from getting wiped out from a health crisis.
If you have ongoing medical issues, insurance will take care of these bills once you reach your deductible. In this instance, it’s important to have a more comprehensive plan through the Marketplace (see below).
But if you’re in reasonably good health, you just need to protect yourself from the big stuff. You don’t need insurance to go a doctor! The cash rate for check-ups or office visits is not that much money, and certainly doesn’t warrant purchasing health insurance, especially the expensive plans!!
Remember that office visit copays on Marketplace Plans do NOT include anything. X-rays, labwork, CAT Scans, MRI’s strep tests, or virtually anything else goes towards your deductible.
So for reasonably healthy people there is no reason to pay $1,000 – $3,000 a month for health insurance. You can get a United Healthcare National PPO plan for $300 – $600 a month per family (or much cheaper for an individual) and pocket an average of $10,000 – $25,000 per year!
The plan has an out of pocket maximum, beyond which it pays 100% for the rest of the year. It also has a $75 urgent care copay. It also includes optional dental, vision, and GAP insurance to cover your deductible.
A deductible is the amount that you must reach before the insurance begins paying. Keep in mind that you usually do not have to meet a deductible to use a copay for the doctor or prescriptions, etc.
Once you reach the deductible, the insurance begins paying a percentage, known as “coinsurance”. If you have an “80/20 plan”, once you reach the deductible the insurance begins paying 80% while you pay just 20%.
Coinsurance is NOT important!!! The reason is because once you reach the out of pocket maximum, the plan will then pay 100% for the rest of the calendar year. In our example above, if by you paying 20% you reach the out pocket maximum, the plan will then pay 100%.
Suppose you have a $5,000 deductible and a $7,000 out of pocket maximum on an 80/20 plan. That means that you are responsible for the first $5,000, the deductible. Once you reach the deductible, the plan begins paying 80% while you pay just 20%. If by you paying 20% you reach an additional $2,000 (totaling $7,000 – your out of pocket maximum), the plan will then pay 100%. So the percentage of coinsurance is not important. You will usually pay a lot more money to have a higher coinsurance percentage (i.e., 80/20 vs 60/40) yet still have the same out of pocket maximum! It’s not worth the extra money.
Keep in mind that copays count towards your out of pocket maximum as well!
Suppose you have a $5,000 or $10,000 deductible. You won’t have to pay it upfront. Think of it as a car payment – you can tell the hospital that you will pay them $100 a month for the next five years. So you will have no problem handling a $5,000 or $10,000 bill. You can also put it on a zero interest or low interest credit card.
You need insurance for the larger bills.
But if you don’t have insurance, you could easily wind up owing hundreds of thousands of dollars. That’s when it becomes a huge problem for many people, and is the reason you and your family need health insurance.
But a higher deductible plan will still offer you and your family excellent protection.
In addition, you can always purchase GAP insurance to cover your deductible in most instances, which leads us to our next question.
GAP insurance covers your deductible in most instances, and can allow you to purchase a much higher deductible plan and still feel quite comfortable.
GAP insurance covers accidents (the number one reason you will take your kids to the ER or hospital), along with many of the most common major illnesses. Cancer, stroke, and heart attack (accounting for 70% of the hospitalizations in the United States) are also covered.
GAP insurance is quite inexpensive, and can save you a lot of money when you combine it with a higher deductible health plan.
1) We can give you a much more comprehensive picture of what’s available. If you call up Blue Cross directly, they will only talk to you about Blue Cross. On the other hand, we are licensed with every company, and can find the best plan and company to fit your needs and your budget.
2) We can enroll you in about 3 – 5 minutes either over the phone or by email. We have completely streamlined the enrollment process.
3) If you have a billing or claim issue, contact us and we can often take care of it for you. It’s much quicker and easier than having to call up the insurance company or marketplace directly, and navigate through a long phone tree just to reach a human voice!
We also have a lot of high level contacts with most companies, and can often quickly and easily resolve your problem.
How would you like to have your own personal assistant to help you with your health insurance? An agent is literally at your beckon call to help you decide on best coverage for you and your family, solve billing and claim issues, and help with any policy changes.
Marketplace plans are compliant with the Affordable Care Act (“Obamacare”), and cover any current or past medical issues. These plans also include free wellness care are usually HMO plans.
The price of these plans literally changes depending on your income. If your income is below a certain threshold, you will receive a discount on your health insurance, known as a subsidy.
These plans are recommended for people who qualify for a substantial savings based on their income or for someone with a major health issue.
As a general rule, if your household income is over the following threshold you will not be eligible for a Marketplace subsidy and in this instance you can simply let us know that you would like the non-subsidized rate.
Individual – the cutoff is close to $48,000
Family of two – the cutoff is $65,000
Family of three – $83,000
Family of four – $100,000
Family of five – $117,000
Family of six – $134,000
Family of seven – $152,000
Family of eight – $160,000
Non-Marketplace plans through the United Healthcare PPO (and other carriers) can literally save you 70% on your health insurance. These plans provide excellent major medical, paying 100% of all medical expenses beyond the plan’s out of pocket maximum.
These plans do not have free wellness care and do not cover medical issues that you have had within the past two years.
However, the heart and soul of health insurance is to simply protect you from major medical expenses. In many cases, it is not worthy paying tens of thousands of dollars in extra premium just to have a free annual check-up.
These plans are highly recommended for people that do not have any major health issues and do not qualify for a substantial discount with the Marketplace plans.
Many families are saving anywhere from $10,000 – $25,000 with these plans.