Individual & Family Health
Health Insurance Solutions for You and Your Family!
In this changing time of health insurance our office specializes in providing you with clear solutions, and advising you of mathematically proven choices.
Good health is our greatest asset, and we must protect it. However, health care is very expensive. Even the most fundamental aspect of health care, prevention, is costly. Few of us can afford to pay the full cost of immunizations, screenings, and lab tests Treatment for common disorders like high blood pressure, elevated cholesterol, and diabetes require, at a minimum, expensive doctor’s visits and prescription medications. Treatment for chronic illness or disease is simply out of reach for most people.
Choosing the Right Policy
Fortunately, health insurance is available to help you offset the high cost of caring for your health. Policies offer individual coverage as well as coverage for spouses and dependents (family coverage).
Policies differ, and they can be tailored to suit your needs and your budget. You will want to look closely at the factors that contribute to the cost of your coverage. Two things account for your cost – the premiums you pay and cost sharing.
Cost sharing takes the form of:
- Deductibles – A policy’s deductible is the amount you pay out of your pocket before the policy begins paying benefits. A deductible may be as low as $200 or as high as several thousand dollars. The higher deductible, the lower the premium. If you are relatively young and healthy and don’t anticipate high medical expenses, you might want to consider a high deductible. You will probably pay most of your medical expenses and never meet your deductible. At the same time, you have coverage in the event of a catastrophic illness or injury.
- Copayments – A copayment is a fixed charge for delivery of a service, for example, $25 for a visit to your primary care physician, $40 to see a specialist, or $10 for a prescription.
- Coinsurance – Coinsurance is a percentage of the cost you will pay for the allowed amount for a service. Assume your plan allows $100 for an office visit and you have met your deductible. If your coinsurance amount is 20 percent, you pay $20.
Which Provider Network is the Best Choice?
Another major consideration when choosing an individual or family plan is the way in which you obtain services – through managed care or a fee for service arrangement. Managed care plans enter into contracts with health care providers and medical facilities to provide care for members at reduced costs. These providers make up the plan’s network.
Managed care plans may be:
- Health Maintenance Organizations (HMOs) – HMOs generally pay for care only if you use a network provider. HMOs do not have deductibles.
- Preferred Provider Organizations (PPOs) – PPOs are structured so that you pay less when you use network providers. If you use an out-of-network provider, you will pay the provider’s standard fee. Typically, out-of-network care does not apply toward your deductible.
- Point of Service (POS) plans – Under these plans, you select a primary care physician from a member list and use only that doctor and the providers he or she refers. Then the plan functions like an HMO. If you go outside the plan, you will have deductibles and coinsurance requirements and will be responsible for charges above the plan’s fee schedule.
Fee for service arrangements, or indemnity plans, pay all or part of the cost of services you use. You will be provided with a list of covered services, for example, office visits and hospital stays, and limitations or exclusions. You can choose any licensed provider you want. There is no network. The plan pays the provider or reimburses you when you file a claim. Indemnity plans can still be found but are very expensive because they have few restrictions.
Don’t Underestimate the Importance
of Dental & Vision Coverage
Dental and vision coverage may be available under individual and family plans. Both emphasize preventive care. Dental insurance generally pays most or all of the cost of routine dental visits and procedures like cleaning, exams, and X-rays. Other services are provided at a discount. Vision insurance usually covers the cost of regular eye exams. Prescription glasses, eyeglass frames, and contact lenses are covered with a copayment.
Click HERE for a Dental Quote
Today’s individual and family health insurance products can be complicated. Contact us so we can help you make wise coverage decisions.
