From an experienced, licensed, independent Life & Health insurance agent who is certified to sell health insurance products on the government health insurance marketplace and directly from health insurance carriers in your state. Do an internet search, ask your friends or a financial advisor or CPA, this should help you find a reputable health insurance specialist.
Making an informed decision on purchasing the health insurance plan that best fits your needs and budget has never been more complicated. There can be much more involved that just looking at the high points of the benefit plan design and the monthly premium. While HealthCare.gov and the state based marketplaces have improved, there are many important issues that the average consumer can and generally does miss in this environment. Purchasing health insurance online is not like getting a hotel room.
If you are a resident of Tennessee, Arkansas or Mississippi please feel free to contact me for assistance.
Insurance Concierge, M&G Insurance, Lake Oswego Oregon
2017: With Affordable Care Act (ACA) - which will have some changes in the near future due to American Care...or what ever it will be called I would suggest keeping an eye on the www.HealthCare.Gov site. They keep up to date rates for all States in the Federal Exchange. For Oregon you can visit www.HealthCareGovApplyNow.com to get rates.
For those not trained in how it works, Insurance can be hard to understand. Deductibles, Co-insurance, Max Out of Pocket (OOP) and Co-payments can be confusing...understanding what you are purchasing, when you purchase health insurance at Open Enrollment next year is important. Let's see if this helps...
CO-PAYS: These are a flat fee chosen by the insurance company that you will pay to a Doctor, Specialist, or Outpatient Mental Health INSTEAD of paying a Deductible for these services. Some plans include Co-Pays for a Vision appointment. Most range from $25-$35. Sometimes these are limited to 2 per year on a Bronze plan. Most HSA plans do not offer Co-Pays as you must pay the Deductible for ALL services.
DEDUCTIBLE: The amount you must pay for Major Services before your Co-Insurance kicks in. Deductibles Range from about $0 - $1,500 on Gold plans, $2,000 - $3,500 on Silver plans and $5,000 - $7,150 on Bronze plans.
CO-INSURANCE: Co insurance is usually paid as 80/20, 70/30 or 50/50. You pay the 80%, or 70% or 50% and the Insurance company pays the other percent. So you pay 80% and the insurance company pays 20%
MAX OUT OF POCKET (OOP): The Max OOP is the MOST you will pay in a calendar year for your health insurance costs, as long as you use doctors and hospitals in your insurance company's network. For 2017 that figure is 7,150 or less per person, depending on what limit each insurance company put on each plan they provide. Bronze plans have the highest Max OOP, with Gold being the lowest Max OOP plans. An insurance company cannot charge more than 2 times the Deductible per family and 2 times the Max OOP per family in a calendar year, for In Network usage.
EXAMPLE of how CO-PAY, DEDUCTIBLE , CO-INSURANCE & MAX OUT OF POCKET WORK:
CO-PAY: Each time you go to the doctor you will pay your Co-Pay, which is a flat fee, for the visit. You will be responsible for any lab, x-rays, or prescriptions which the doctor prescribes at this visit as they are not included in your co-pay. HSA's will not have a co-pay up front because you must pay the full deductible for all services rendered, before an Insurance company will pay anything for you on an HSA plan.
DEDUCTIBLE, CO-INSURANCE & MAX OOP: When a bill comes in for a major service, such as an ambulance ride, overnight stay in the hospital or MRI, you will be responsible to pay the amount of your deductible first. After you have paid the amount of your deductible, most times, you will have to pay a co-insurance amount. Most co-insurances are 80/20, 70/30 or 50/50. That means you pay the next 80% of each bill that comes in, up to the Max Out of Pocket (OOP) for your plan, for all doctors and hospital charges which are in network charges. The insurance company pays the 80% that you didn't pay (if your co-insurance is 80/20). After the Max Out of Pocket is paid you would owe 0% (as long as you used doctors and hospitals whom are in network) and the insurance company then pays 100% of all future bills until Dec 31st. Each year you start all over having to pay your deductible, co-insurance and Max OOP.
EXAMPLE: Your deductible is 2,500 and your Max Out of Pocket is 7,150 (7,150 is the most which can be charged for 2017) and your co-insurance is 20%
You pay the first 2,500 of a 15,000 claim and that leaves 12,500. You are then responsible to pay 20% (or 30% or 50% depending on the plan you choose) which is an additional 2,500. The insurance company pays the other 80%. That means for this claim of 15,000 your total is the deductible of 2,500 and the 20% coinsurance above of 2,500 for a total of 5,000. You would NOT have met your Max Out of pocket for the year (7,150) so the next bills which come in you are responsible to pay 20% of each one, until you have reached a total paid of 7,150 (INCLUDING the 2,500 deductible). Keep in mind that co-pays do not go towards the deductible in most cases and neither do prescriptions; however they do go towards the Max Out of Pocket for the year.
If you have any further questions please feel free to get in touch with me. kylab@mgbenefits.com
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Making an informed decision on purchasing the health insurance plan that best fits your needs and budget has never been more complicated. There can be much more involved that just looking at the high points of the benefit plan design and the monthly premium. While HealthCare.gov and the state based marketplaces have improved, there are many important issues that the average consumer can and generally does miss in this environment. Purchasing health insurance online is not like getting a hotel room.
If you are a resident of Tennessee, Arkansas or Mississippi please feel free to contact me for assistance.
For those not trained in how it works, Insurance can be hard to understand. Deductibles, Co-insurance, Max Out of Pocket (OOP) and Co-payments can be confusing...understanding what you are purchasing, when you purchase health insurance at Open Enrollment next year is important. Let's see if this helps...
CO-PAYS: These are a flat fee chosen by the insurance company that you will pay to a Doctor, Specialist, or Outpatient Mental Health INSTEAD of paying a Deductible for these services. Some plans include Co-Pays for a Vision appointment. Most range from $25-$35. Sometimes these are limited to 2 per year on a Bronze plan. Most HSA plans do not offer Co-Pays as you must pay the Deductible for ALL services.
DEDUCTIBLE: The amount you must pay for Major Services before your Co-Insurance kicks in. Deductibles Range from about $0 - $1,500 on Gold plans, $2,000 - $3,500 on Silver plans and $5,000 - $7,150 on Bronze plans.
CO-INSURANCE: Co insurance is usually paid as 80/20, 70/30 or 50/50. You pay the 80%, or 70% or 50% and the Insurance company pays the other percent. So you pay 80% and the insurance company pays 20%
MAX OUT OF POCKET (OOP): The Max OOP is the MOST you will pay in a calendar year for your health insurance costs, as long as you use doctors and hospitals in your insurance company's network. For 2017 that figure is 7,150 or less per person, depending on what limit each insurance company put on each plan they provide. Bronze plans have the highest Max OOP, with Gold being the lowest Max OOP plans. An insurance company cannot charge more than 2 times the Deductible per family and 2 times the Max OOP per family in a calendar year, for In Network usage.
EXAMPLE of how CO-PAY, DEDUCTIBLE , CO-INSURANCE & MAX OUT OF POCKET WORK:
CO-PAY: Each time you go to the doctor you will pay your Co-Pay, which is a flat fee, for the visit. You will be responsible for any lab, x-rays, or prescriptions which the doctor prescribes at this visit as they are not included in your co-pay. HSA's will not have a co-pay up front because you must pay the full deductible for all services rendered, before an Insurance company will pay anything for you on an HSA plan.
DEDUCTIBLE, CO-INSURANCE & MAX OOP: When a bill comes in for a major service, such as an ambulance ride, overnight stay in the hospital or MRI, you will be responsible to pay the amount of your deductible first. After you have paid the amount of your deductible, most times, you will have to pay a co-insurance amount. Most co-insurances are 80/20, 70/30 or 50/50. That means you pay the next 80% of each bill that comes in, up to the Max Out of Pocket (OOP) for your plan, for all doctors and hospital charges which are in network charges. The insurance company pays the 80% that you didn't pay (if your co-insurance is 80/20). After the Max Out of Pocket is paid you would owe 0% (as long as you used doctors and hospitals whom are in network) and the insurance company then pays 100% of all future bills until Dec 31st. Each year you start all over having to pay your deductible, co-insurance and Max OOP.
EXAMPLE: Your deductible is 2,500 and your Max Out of Pocket is 7,150 (7,150 is the most which can be charged for 2017) and your co-insurance is 20%
You pay the first 2,500 of a 15,000 claim and that leaves 12,500. You are then responsible to pay 20% (or 30% or 50% depending on the plan you choose) which is an additional 2,500. The insurance company pays the other 80%. That means for this claim of 15,000 your total is the deductible of 2,500 and the 20% coinsurance above of 2,500 for a total of 5,000. You would NOT have met your Max Out of pocket for the year (7,150) so the next bills which come in you are responsible to pay 20% of each one, until you have reached a total paid of 7,150 (INCLUDING the 2,500 deductible). Keep in mind that co-pays do not go towards the deductible in most cases and neither do prescriptions; however they do go towards the Max Out of Pocket for the year.
If you have any further questions please feel free to get in touch with me. kylab@mgbenefits.com