INDIVIDUAL MEDICAL INSURANCE | stressmanagement

Understanding Indiviual Insurance

Individual healthcare has drastically changed in last ten years, since the introduction of Obama Care. Most policies have high deductibles and out of pocket Maximums. Some have copays for Dr. and labs. It is important to have help navigating on Heathcare.gov. To help you understand and qualify for premium discounts please call.... remember my services are FREE

Deductables

A deductible is the amount you pay for health care services before your health insurance begins to pay.

For example, if your deductible is $1,500, you would pay 100 percent of your health care charges until the amount you paid reaches $1,500. After that, some services you receive may be covered at 100 percent, or you may have to pay coinsurance.

Co-insurance

Coinsurance is your share of the costs of a health care service. It’s usually figured as a percentage of the total charge for the service. You pay coinsurance plus any deductibles you still owe.

Say you’ve already paid out (or met) your $1,500 deductible and your coinsurance is 20 percent. For a $100 health care bill, you would pay $20 and your insurance company would pay $80.

No Pre-Existing Conditions

With Obama care going in to effect the insurance companies are changing the way they can underwrite. Although this will allow people with pre-existing conditions to get insurance it will also raise the rates of health people because they will no longer be able to discount for health. This went into effect Jan of 2014

Doctor Visit options

A copay is a fixed amount you pay for a health care service, usually when you receive the service. The amount can vary by the type of service. You may also have a copay when you get a prescription filled. In most cases, copays don’t count toward your deductible.

For example, a doctor’s office visit might have a copay of $30. The copay for an emergency room visit will usually cost more, such as $150.

Co-pays

Some insurance plans are adding a

Dr. office visits in network benefit

you pay a setcopay, no deductible or coinsurance. Some have limited number of visist and some are unlimited and fee vary by plan

pharmacy coverage

Many plans are now including drugs

These benefits either have a separate deductable or they may be part the total plans decuctable and then the tier pricing begins

What is a Formulary?

Your payer, whether it is a private insurance company, Medicare, Tricare, Medicaid or another program maintains a list of drugs it will pay for called its formulary. Its formulary is comprised of generic drugs, prescription drugs and sometimes over-the-counter drugs (OTC) that were previously prescription-only drugs. For example, Prilosec and Naproxen used to be prescription only, but both are now OTC drugs. Some payer plans include Prilosec and Naproxen in their formularies.

What Are Formulary Tiers?

Tiers are groups of drugs that fall within description and pricing groups: Tier 1 being the lowerst

Dental

Most plan offer some type of dental coverage. There are a variety of stand alone plans. These plans vary greatly please take note of the dudctables, max yearly benefit and or preventative coverage. Plans run from 30 to 60 a month

Vision

Wellness

Vision is usually available for under 20 dollar, but the benefits are usually not that rich.

Preventive Care Benefits:

Benefits include coverage for the following (depending on the covered person’s age and gender):• Routine Vaccines for diseases.• Flu and pneumonia shots.• Routine physical exams, including well-baby and well-child doctor visits. • Screening for high blood pressure, cholesterol, diabetes.• Screening for detection of breast and other cancers through mammogram, pap smear, prostate cancer screening and colorectal screening.• Women’s preventive services. Preventive Care benefits are exempt from your Plan deductible, coinsurance, and copayments when services are provided by a network provider. Preventive health services must be appropriate for the covered person and follow these recommendations and guidelines