Health Insurance Surprise AZ
Health Insurance Plans in Surprise, AZ
What type of Health Insurance Plan is right for you?
With health insurance, there are many types of plans available. Those include, but not limited to, short term health plans, major medical plans, Affordable Care Act plans, employer-based group plans, catastrophic healthcare plans, and hospital/healthcare indemnity plans. Each of these insurance plans address a specific need.
Here are some examples.
Short Term Healthcare Plans are great for individuals or families that are looking to fill a gap in coverage. Maybe you are starting a new job in a few months and are leaving a current employer. Maybe you are going back to school for a couple semesters and losing your group healthcare plan.
Major medical plans are healthcare plans offered by the major healthcare insurance companies like Blue Cross Blue Shield, Aetna, Cigna, and more. These plans are what most people associate with your traditional health insurance plans. They come in all shapes, sizes, coverage options, and price points. This is why we encourage our clients to sit down with us so we can develop a personalized insurance profile to find the right coverage for you. Time and time again, we see families selecting plans based on what they perceive or because a friend told them it was a great plan that “covered everything!” Sadly, this can put you in a really bad place long term and cost you in the long run.
Affordable Care Act plans are also referred to as marketplace plans. These plans or plan types were developed in 2010 under President Obama to combat the rising cost of healthcare and prescription drug coverage. These plans are all administered by private insurance companies and regulated by the federal government. These plans are required to include basic coverage like routine exams, prescription drug coverage, hospital care, and more designed to provide access to healthcare for more Americans.
Employer-based group plans are health insurance plans provided by your employer. In the Federal and State laws require employers with a certain number of staff to provide coverage at certain levels. Typically, most employers will cover a certain amount of the monthly premium and you, the employee, picks up the balance. All employer sponsored group plans are different, providing various levels of coverage, deductibles, and more. Believe it or not, employer sponsored group plans are not always the best option for an individual. To understand what your out-of-pocket risk is, we encourage you to meet with us so we can review your coverage options.
Catastrophic healthcare plans typically provide coverage for major issues such as extended hospital stays, emergency surgeries, and more. Just as the name implies, they are for catastrophic incidents. Most people use these plans to provide an additional level of coverage when a major medical plan or other health insurance plan provides certain coverage limitations.
Next up, we have healthcare or hospital indemnity plans. These plans provide specific coverage levels for specific services. Some individuals really like these plans because they know exactly what is covered and what isn’t, and exactly how much is covered. These let you really take charge of your healthcare and shop around for more affordable healthcare options. Most indemnity plans are on a reimbursement basis, however some plans do provide some in-network benefits that are paid directly to the provider. These plans are becoming increasingly popular with consumers as they are typically more affordable than traditional major medical plans.
While there are several other types of healthcare insurance plans available, as a consumer or business, it is always in your best interest to work with an independent insurance agent to help you find the best coverage, at the best price, that addresses all your individual and family needs. Give us a call today and schedule your meeting today!
Health Insurance FAQ
A monthly payment you make to have health insurance. Like a gym membership, you pay the premium each month, even if you don’t use it, or else lose coverage. If you’re fortunate enough to have employer-provided insurance, the company typically picks up part of the premium.
A predetermined rate you pay for health care services at the time of care. For example, you may have a $25 copay every time you see your primary care physician, a $10 copay for each monthly medication and a $250 copay for an emergency room visit.
The deductible is how much you pay before your health insurance starts to cover a larger portion of your bills. In general, if you have a $1,000 deductible, you must pay $1,000 for your own care out-of-pocket before your insurer starts covering a higher portion of costs. The deductible resets yearly.
Coinsurance is a percentage of a medical charge that you pay, with the rest paid by your health insurance plan, that typically applies after your deductible has been met. For example, if you have a 20% coinsurance, you pay 20% of each medical bill, and your health insurance will cover 80%.
The most you could have to pay in one year, out of pocket, for your health care before your insurance covers 100% of the bill.
How they all work together
Health insurance policies can have a variety of cost-sharing options. Some policies have low premiums and high deductibles and out-of-pocket maximum limits, while others have high monthly rates and lower deductibles and out-of-pocket limits.
In general, it works like this: You pay a monthly premium just to have health insurance. When you go to the doctor or the hospital, you pay either full cost for the services, or copays as outlined in your policy. Once the total amount you pay for services, not including copays, adds up to your deductible amount in a year, your insurer starts paying a larger chunk of your medical bills, typically 60% to 90%. The remaining percentage that you pay is called coinsurance.
You’ll continue to pay copays or coinsurance until you’ve reached the out-of-pocket maximum for your policy. At that time, your insurer will start paying 100% of your medical bills until the policy year ends or you switch insurance plans, whichever is first.