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Health Insurance Plans

Health care has not only become increasingly expensive, it has also gotten more complicated.  Navigating through the various types of plan network  is often confusing.  Let us assist by ensuring the types of plan will fit your lifestyle. 

 

Transparency of benefits, services, and cost predictability are all considerations to ensure affordability.  We offer health insurance coverages that are straight forward and does not need to be purchased on the ACA marketplace.  

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With professional guidance, you can confidently select and package the right products to ensure your plan meets your need.  Let's inspect four of the most popular types of insurance networks: 

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                                   PPO   -  Preferred Provider Organization

                                   HMO - Health Maintenance Organization

                                   EPO   - Exclusive Provider Organization

                            POS   - Point Of Service

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PPO

  • Lower cost for in network provider services

  • Larger network of Providers

  • Out of network services available, often at a higher cost

  • No referrals for specialist

  • Does not need to select a PCP

  • Highest in premiums

  • Lower deductibles

  • Higher co-pays and coinsurance

  • Flexibility and ease of use

  • PPO's are best for individuals who travel often and have frequent specialized medical needs

HMO

  • Must stay in network for services and specialist visits

  • Smaller network of providers

  • Out of network covered for required and essential  emergency services only

  • Referral needed for a specialist

  • Must select a PCP

  • Lower premiums, especially on over 65 plans

  • Deductible on under 65 plans

  • Low Co-pays and coinsurance

  •  Expect lot's of care coordination and specialist referrals

  • HMO's are suited for those who need care by utilizing a managed care network 

EPO

  • Lower cost on in network provider services

  • Smaller network of Providers

  • Out of network services for true Emergency services only

  • Non Emergency out of network use denied

  • No Referral required for In network providers and specialist 

  • Prior authorization may be required for specialized care

  • PCP selection not required by most carriers, but encouraged

  • Lower premiums

  • Low set dollar plan deductibles

  • Deductible needs to be met before insurance pays

  • Lower co-pays and coinsurance

  • EPO's are ideal for the individuals living in densely populated areas due to the very tight network of  providers

  • Care coordination may not be smooth and requires your follow up. 

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POS

  • Lower cost on in network services

  • Smaller network of Providers

  • No Referrals for in-network specialist

  • May see out of network providers for services at a higher cost

  • Out of network coverage for essential and required  Services 

  • No or very low deductible

  •  Must select a PCP for care and specialist coordination

  • Lower to average premiums

  • Deductible needs to be met for under 65 plans

  • Lower co-pays and coinsurance

  • Flexibility for in network use

Insurance Expenses that burn a hole in your budget can be avoided with proper planning.  Looking for a health insurance plan without out of pocket (OOP) expenses, is a needle in a haystack.  Let's take a look at the four common types of (OOP) insurance expenses.

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         Premiums         Co-pays        Co-insurance      Deductibles

Premiums

  • Premiums are a set dollar amount you pay every month to the carrier for being a member of the plan

  • Premiums are required for most insurance policies

  • Some Medicare plans may offer zero or no premium plans

  • You must pay your monthly, quarterly or annual premiums to keep coverage in force

  • Premiums entitles you to member benefits based on your plan

Copays

  • Your copays are set dollar amounts you pay for each visit to your PCP primary care, specialist, Urgent or emergency care. 

  • Each event has a different dollar amount that you pay on each occasion or visit.  

  • Your copays may or may not increase each year. It's important you read your coverage change notice each year if you have the same plan.

Coinsurance

  • Coinsurance kicks in once you have met your deductible.  Your insurance company will not pay for their portion of services until your deductible is met.

  • Coinsurance is the percentage or split that you pay for services.  For example you may pay 20% and your insurance company pays 80%. Which means you're responsible for 20% of the cost of services rendered 

  • Coinsurance percentages differs based on the plan type, and deductible amount. 

  • Coinsurance is generally paid in addition to premiums and copays

Deductibles

  • Deductible is the set dollar amount that you must first spend for services before the insurance company starts paying their percentage. 

  • Deductible amounts are different based on the type of plan, such as HMO, EPO or PPO.

  • Once you meet your deductible, your insurance company will start paying their portion or percentage for covered services

  • Deductible amount to meet generally starts over annually depending on your plan or insurance carrier

  • Some insurance plans will offer services such as your well care visits before your deductible is met

  •  Higher deductibles means lower monthly premiums

  • Lower deductibles means Higher monthly premiums

Let us help you eliminate the surprises and angst when emergency services are required?  We will assist in finding plans that meet your current Lifestyle and health needs with a comprehensive and or supplemental health plan. Request a no obligation consultation to avoid these hidden out of pocket (OOP) expenses. 

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Always refer to your plans Summary of Benefits and Evidence of Coverage to avoid expensive surprise bills.  Pay special attention to referrals and

pre-authorizations.  Always ask your doctor if they are still in network.  Get your pre-authorization and referrals in writing from your PCP.  Review you Change of Coverage every year to ensure there are no changes to your plan.  

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         Find out how to  supplement your health plans to avoid hidden expenses such as high deductibles, copays and coinsurance.  

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