You and every member of your family! Let’s face it, one hospital stay could wipe out your savings, and cause future financial hardship. Why take a chance? Especially since health care has never been better! We can put you in touch with an experienced insurance professional that could help you find the plan that’s right for you-whether you’re looking for yourself, your family, or your company. They can help you find a plan that provides access to quality health care at reasonable rates.
The differences between fee-for-service, HMO, and PPO insurance plans are not as clear-cut as they once were. HMO’s and PPO’s are offering more freedom to choose doctors, the way fee-for-service plans do. By studying your health insurance options carefully, you will be able to pick the one that provides you with the coverage you need. For HELP with choosing the proper insurance plan for you and your family, fill out our online form!
- Fee-For-Service (or Traditional Health Insurance).
This is the traditional kind of health care policy. Insurance companies pay fees for the services provided to the insured people covered by the policy. This type of health insurance offers the most choices of doctors and hospitals. You can choose any doctor you wish and change doctors any time. You can go to any hospital in any part of the country.
- Health Maintenance Organizations (or HMO’s).
The HMO arranges for this care either directly in its own group practice and/or through doctors and other health care professionals under contract. Usually, your choices of doctors and hospitals are limited to those that have agreements with the HMO to provide care. However, exceptions are made in emergencies. There may be a small co-payment for each office visit, such as $5 for a doctor’s visit or $25 for hospital emergency room treatment. Your total medical costs will likely be lower and more predictable in an HMO than with fee-for-service insurance. Because HMO’s receive a fixed fee for your covered medical care, it is in their interest to make sure you get basic health care for problems before they become serious. HMO’s typically provide preventive care, such as office visits, immunizations, well-baby checkups, mammogram’s, and physicals. The range of services covered varies in HMO’s, so it is important to compare available plans. Some services, such as outpatient mental health care, often are provided only on a limited basis. Many people like HMO’s because they do not require claim forms for office visits or hospital stays. Instead, members present a card, like a credit card, at the doctor’s office or hospital. However, in an HMO you may have to wait longer for an appointment than you would with a fee-for-service plan. In some HMO’s, doctors are salaried and they all have offices in an HMO building at one or more locations in your community as part of a prepaid group practice. In others, independent groups of doctors contract with the HMO to take care of patients. These are called individual practice associations (IPA’s) and they are made up of private physicians in private offices who agree to care for HMO members. You select a doctor from a list of participating physicians that make up the IPA network. If you are thinking of switching into an IPA-type of HMO, ask your doctor if he or she participates in the plan. In almost all HMO’s, you either are assigned or you choose one doctor to serve as your primary care doctor. This doctor monitors your health and provides most of your medical care, referring you to specialists and other health care professionals as needed. You usually cannot see a specialist without a referral from your primary care doctor who is expected to manage the care you receive. This is one way that HMO’s can limit your choice. Before choosing an HMO, it is good ideas to talk to people you know who are enrolled in it. Ask them how they like the services and care given.
- Preferred Provider Organizations (or PPO’s).
The preferred provider organization is a combination of traditional fee-for-service and an HMO. Like an HMO, there are a limited number of doctors and hospitals to choose from. When you use those providers (sometimes called “preferred” providers, other times called “network” providers), most of your medical bills are covered. When you go to doctors in the PPO, you present a card and do not have to fill out forms. Usually there is a small co-payment for each visit. For some services, you may have to pay a deductible and coinsurance. As with an HMO, a PPO requires that you choose a primary care doctor to monitor your health care. Most PPO’s cover preventive care. This usually includes visits to the doctor, well-baby care, immunizations, and mammogram’s. In a PPO, you can use doctors who are not part of the plan and still receive some coverage. At these times, you will pay a larger portion of the bill yourself (and also fill out the claims forms). Some people like this option because even if their doctor is not a part of the network, it means they don’t have to change doctors to join a PPO.
- Government Sponsored Health Programs
Medicare is a federal program, which provides medical coverage for people over the age of 65, and for those who are permanently disabled. Contact your local Social Security office for more information and enrollment instructions.
- Medicare Supplement Insurance Program
This insurance helps cover some of the gaps in health insurance plans or Medicare coverage. Some health needs, such as, dental and eye care are not included in some health insurance plans. So pay attention to your needs and what the insurance company offers!
If your employer does not offer group insurance or their plan doesn’t provide you enough coverage to obtain health insurance then you can buy an individual policy. This type of plan is also used by anyone who works for themselves, a contractor or self employed person. This individual insurance plan however, may not offer benefits as broad as those in group plans and co-pays may be more.
Group coverage is usually cheaper than individual policies, due to the fact that many people have insurance though their employer that purchase many insurance policies, so the insurance companies can lower the price. As with most marketing the more you purchase the lower the price. Group insurance is usually paid for in full or in part by the employer this is usually part of your employee package. Some employers offer you to pick your plan (HMO or PPO) In addition, some group plans offer dental insurance as well as medical. Other organizations offer group health insurance as well. Places like:
The law requires you, the employer of 20+ employees to provide COBRA (Consolidated Omnibus Budget Reconciliation Act). This plan offers employees and covered family members the continuation of group health benefits (Medical, Dental, Vision and Medical Reimbursement Account) upon a qualifying employment termination. Employers are required to provide initial COBRA notification to covered employees and dependents, and must send employees a letter detailing an individual’s rights upon experiencing a qualifying event and an explanation of the conversion privilege. The legislation defines the following six situations as
Termination of Employment
Reduction of Work Hours
Employee’s Death
Employee’s Divorce (or legal separation in some states)
Medicare Entitlement
Change in Dependent Status
Health insurance coverage is available from insurance companies; like Blue Cross and Blue Shield, PacifiCare, HealthNet and Kaiser, etc. There are many insurance companies to choose from, so let us help you find the best one for you! Here are some of the things to look at when choosing and comparing health insurance plans.
- Physician visits
- Physician visits in the hospital
- Physician Office visits
- Medical tests
- Medical X-rays
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Prescription drugs
- Inpatient and Outpatient hospital services
- Nursing care
- Mental health care
- Physical therapy
- Speech therapy
- Hospice care
- Maternity care
- Checkups
- Baby care
- Dental care
- Service limits
- Service exclusions
- Pre-existing conditions exclusions
- Preventive care and checkups
- Family Coverage
- Any age restrictions for you or your family
- Does this include Long Term Care Insurance
- Does this include Disability Insurance
- Choice of providers
- Amount of copays for doctors and medicine.
- Does plan change after age 65
- Will this policy be able to cover your needs through retirement
- Insurance Agent
- Credit Unions.
- Professional clubs.
- Professional Organizations.
- Some other financial institutions.
- Some colleges and universities.
Before purchasing health insurance you should first do some research. That’s where we can help you! We will also send your request for a health insurance quote to a qualified health insurance professional that will be able to answer any other questions you may have and provide you with a health insurance quote, at no obligation and free of charge.
Fraud is an intentional deception that someone makes, that could result in an unauthorized insurance payment. Whether it is successful or not, it is still fraud. Abuse involves actions that are inconsistent with accepted normal practices. Abuse directly or indirectly results in unnecessary costs to the insurance program through improper payments. The real difference between fraud and abuse is the person’s intent.
No matter who commits a fraudulent claim, it costs us all in higher premiums and overall costs of our health insurance plans. So if you believe there has been a fraudulent action, report it immediately to one of the agencies list at left.
This is a term used to refer to a course of treatment seen as the most helpful for your health issue. The course of treatment is deemed necessary by your physician, specialist or hospital. This course of treatment strives to provide you with the best care in the most appropriate setting.
The letters C O B R A stand for Consolidated Omnibus Budget Reconciliation Act of 1985. COBRA is a federal law that allows an individual to continue paying for health coverage if they lose their job. Check with your Human Resources Department to see if your employer is subject to this law, and if you are eligible for COBRA coverage.
A Primary Care Physician is trained to manage your entire health care program. Your Primary Care Physician plays many roles – primary caregiver, health care advisor and consultant, coordinator of specialty care and patient advocate
Primary Care Physicians can include:
- Family/General Practitioners (Doctors who treat patients of all ages)
- Internists (Doctors who treat adults and may have a subspecialty)
- Pediatricians (Doctors who treat children)
- Gynecologist (Doctors who treat women)
Just fill out our free, no-obligation Health Insurance quote form. Your information will be passed on to a qualified, licensed health insurance broker. This broker will contact you directly to provide you with an insurance quote and will be able to answer any questions you may have. This broker will be from your state area, with knowledge of your state insurance programs. This broker will provide you with information and advice on coverage options and cost savings measures.
