health insurance help Archives - Page 23 of 29

How Family Deductibles Work

There are many advantages to purchasing a family health insurance plan. Having one of these plans is much cheaper than paying for individual plans for each person in your family, and will give you peace of mind knowing that everyone in your household is fully covered. While you will only need to pay one monthly premium with a family health plan, you do need to be aware that there are typically two kinds of deductibles involved: individual deductibles and a family deductible. Having multiple deductibles can seem a little confusing, but it is simple once you know what to expect.

caucasian doctor standing up handing a caucasian man sitting down a paper — *If your doctor orders a procedure or lab work, then you have to meet your deductible before insurance pays.*

What Is a Deductible?

When you go to the doctor, get lab work done, have surgery, and even buy prescription drugs, your health insurance company pays a portion of your expenses. But, in order for your insurer to begin paying these expenses, you must first meet your deductible. Your deductible is the amount of money you have to pay out-of-pocket before your health insurance company will start paying for your medical expenses.

Individual deductibles apply to one person on the policy, and the family deductible applies to total costs incurred by ALL members on the policy.

Meeting Your Deductibles

Although your plan will have both individual deductibles and a family deductible, you will not be required to meet both deductibles before your plan starts paying out for your medical expenses. The following is a breakdown of how these two kinds of deductibles work:

If a family member meets their individual deductible, then the insurance company will start paying their claims, even if the family deductible has not been met yet.
Once the family deductible is met, then the insurance company will begin to pay everyone’s expenses, and members will no longer need to meet their individual deductibles.

The family deductible system is the same as having what is known as an embedded deductible. This means that individual deductibles are embedded within the family deductible and will count toward the family deductible. Generally, a family deductible is double what a plan’s individual deductibles are. For example, if the individual deductibles are $500, then the family deductible will be $1,000.

To simplify how it all works, let’s use an example:

A family of four has a family deductible of $1,000 and individual deductibles of $500 each:

Mom has surgery and pays her $500 deductible. That $500 also goes towards the $1000 family deductible, leaving $500 to pay towards that deductible. Mom no longer has to pay out of pocket for her individual medical costs. However, dad and their two children will have to pay for any medical expenses until they meet their individual deductibles.
One child in the family has a trip to urgent care and incurs $300 in medical expenses, which will go towards the child’s individual deductible. This will also go towards the remaining $500 of the family deductible, and now the family will only have $200 left for their family deductible to be met. The child also has $200 left on their individual deductible ($500 – $300 = $200) before insurance will begin to pay their bills.
Dad gets blood work done and has to pay $200 in deductible costs. That $200 goes towards the family deductible, meaning they have reached their $1,000. Now that the family deductible is finally met, everyone in the family (even those who did not meet their own deductibles) can receive care and the insurance company will pay for any medical expenses incurred.

What Is Not Included In Your Deductible

There are instances in which you or a family member will receive care that does not count towards your deductible. Things that are not covered by your health insurance plan, such as out-of-network care, will not count towards your deductible. If you choose to see an out-of-network doctor, or get elective surgery that insurance does not cover, then the costs will be completely out-of-pocket and will not count towards your deductible.

white pill bottle laying sideways on a yeallow table with white round tablets spread out of it. — *Medication costs, among other costs, does not go towards your deductible.*

Copayments and prescription costs don’t count towards your deductible either. Certain types of preventative care are also paid for by your insurer without you having to meet your deductible before they will begin to pay their portion of the costs.

Unfortunately, deductibles are a necessary part of having health insurance, and are not something we can opt out of. The way that deductibles work with a family health insurance plan can be confusing: you might assume that if you have a family deductible to meet, then you would not have individual ones as well. But the good news is that paying your individual deductibles goes towards the family deductible.

If you are looking for a plan that will cover your family without breaking the bank, EZ can help. We work with the top-rated insurance companies in the country and can compare plans in minutes. Health insurance costs are on the rise and can be expensive, which is why we offer our services for free. Our goal is to provide you with quotes on affordable plans and to save you money, all without making a dime off of you, because health insurance is costly enough!

To compare quotes for free, simply enter your zip code in the bar above, or to speak to one of our agents, call 888-350-1890.

Beware of Post-Claims Underwriting

Having health insurance is necessary for keeping you protected in the event of an emergency or accident. A full-coverage plan is usually your best bet, but in some cases you might decide to opt for a short-term plan. For example, if you missed Open Enrollment and need a plan quickly you might choose one of these plans for convenience. Or, if you are healthy and rarely visit the doctor, you might choose one of these plans to save money on premiums, since they are usually less expensive than traditional plans.

caucasian hand with a pen filling out a survey — *Insurance companies are no longer allowed to medically underwrite you during the sign-up process, but short-term plans can.*

Unfortunately, if you are not careful when picking out your short-term health plan, you might end up dealing with post-claims underwriting. Some insurance companies bait consumers into choosing their short-term plans, only to turn around and use this tactic to deny customers their insurance payouts after a claim is made. To avoid post-claims underwriting, you have to know what it is; you should also work with a reputable agent to know that you have the right plan from the right insurance company.

Medical Underwriting

Before the protections of the Affordable Care Act (ACA), major medical health insurance plans could force customers to undergo the medical underwriting process before choosing whether to insure them. This meant that you would have to fill out a questionnaire based on your pre-existing health conditions, and if you were considered high-risk, they could deny you coverage or charge you a higher premium based on your medical history.

Although the ACA ended medical underwriting for major medical health insurance plans in 2014, it still applies to short-term health insurance plans and Medicare Supplement Plans if someone enrolls after their Initial Enrollment Period.

Post-Claim Underwriting

Short-term health plans are not subject to any ACA regulations, so with these plans, insurance companies can still use the underwriting process to choose who they want to insure and how much to charge for coverage. But in some cases, instead of being thorough in the underwriting process, insurance companies that offer short-term plans will not fully evaluate the risk of a customer before agreeing to insure them. Instead, the insurance company will evaluate the risk of the customer after a claim is made. This is called post-claims underwriting, and it can end up costing you thousands in medical expenses.

When using post-claims underwriting, insurance companies will look for a reason to deny claims by asking questions that should have been asked before the policy was sold. Generally the insurance company will do this to try and take your premium payments without intending to pay out on your claims. They will issue you a policy with little to no investigation, giving you a simple application with yes or no answers. For example, they might simply ask you if you are in good health; if you check yes, then, once you file a claim, they will investigate your prior health issues and will use your answer against you. If you have a stroke, for example, while covered by the plan, the insurance company might investigate your actual health status prior to the stroke and would use any information they found to deny your claim.

Avoiding Post-Claims Underwriting

Unfortunately, some health insurance companies that offer short-term plans still engage in the practice of post-claims underwriting. To avoid being swindled into buying one of these plans, there are some steps you can take. Before signing up with a company, examine their application and ask questions if you don’t understand it. This may not be enough, though; the best way to make sure that you are fully insured and protected is to work with an insurance agent. EZ.Insure works with some of the top rated-companies in the country, and will go through the application process with you. Our agents are honest and will make sure that you understand your policy, and that you won’t have any rugs pulled out from under you when you file a claim. We might even be able to find a health insurance plan that is not allowed to medically underwrite at a more affordable price than that of a short-term plan!

Avoid confusion and any possibility of being denied coverage in the future by working with an EZ agent. Our agents are highly-trained, honest, and work with your best interests in mind. To get free quotes on plans in your area, simply enter your zip code in the bar above. Or to speak directly to an agent, call 888-350-1890.

Preparing For Health Insurance Open Enrollment: Tips To Save Money

The Health Insurance Open Enrollment Period is over. To get the most savings, this year take a deep dive into all the plans available in your area, instead of just renewing your health insurance plan out of habit. If you use the following tips, you might find that there is a plan that covers all your medical needs AND helps you save money.

Find Out if You Qualify for Premium Tax Relief & Cost-Sharing Reductions

Did you know that over 80% of people who enroll in a Marketplace plan receive premium tax credits? Qualification for premium tax credits is based on household income; you can qualify if your household income is at least 100% but no more than 400% of the federal poverty line. If you do qualify for a premium tax credit, you will have the choice to receive the full amount of the credit in advance, so that you can reduce your premiums up front, or you can wait to get the credit when you file your taxes.

If your household income is up to 250% of the federal poverty line, you will be eligible for cost-sharing reductions on copays and coinsurance. In order to receive this benefit, you must be enrolled in a Silver plan; as long as you qualify for this benefit, it will be automatically included as part of your plan.

Consider Your Medical Needs

Do you have a chronic condition that requires ongoing treatment? Medications that you regularly take? Do you have family members with chronic conditions or who need medications? Do you plan on expanding your family? These are just some of the questions you need to ask yourself as you consider your plan for next year. Look closely at your medical expenses from last year, make a list of what you think your needs will be for next year, and figure out how much you can afford to spend on premiums. Remember to also take into account the costs of copays, coinsurance, and deductibles.

Do NOT Automatically Choose the Cheapest Plan

It is always tempting to save money by opting for the cheapest plan available. But this can end up costing you more in the long run, especially if you or a family member ends up having an emergency or becoming ill. Some cheap plans look good on paper, especially since all ACA-approved plans have to cover the 10 essential benefits, but they might have some exclusions in the fine print. Remember that, while all plans cover the 10 essential health benefits, there is no guarantee that a plan will cover any specific service or medication within the 10 categories.

Purchasing a cheap plan might seem like a good way to save money, but in the event that you need coverage for something specific, you could end up spending all the money you thought you were saving on out-of-pocket expenses. Remember, too, that cheap plans tend to have high deductibles, so you will have to pay a lot out-of-pocket before your plan begins to cover your medical expenses.

round blue pills spilling out of prescription bottle on top of hundred dollar bills. — *Save on medication by opting for generic brand or a plan with your medicine on a lower-priced drug formulary tier.*

Save On Medications

Prescription medications are not cheap, especially when you need to regularly purchase medications to treat a chronic condition. To save money, you can opt for generic brand medications, which are usually cheaper. This is because they will generally be in a lower-priced tier in your plan’s drug formulary. Your plan’s formulary will tell you how much you will have to pay for each drug, so as you research plans, make sure to check their drug formularies to see which of your medications might be in a lower-priced tier .

Work With a Reputable Agent

Remember, Open Enrollment is ending soon, so you need to compare plans quickly! The best thing to do at this point is to work with an EZ.Insure agent, who will instantly give you quotes from all available plans in your area. We will show you all of your options, as well as look for any discounts or subsidies you might be eligible for.

Come to EZ and you will work with just one agent who will help guide you to the plan that best suits your medical and financial needs. Our goal is to help you save the most money while getting the most coverage for you and your family’s needs. Do not wait until the last minute and end up settling for a plan that doesn’t fit your needs. To get instant free quotes, simply enter your zip code in the bar above, or to speak to an agent, call 888-350-1890.

Preparing For Health Insurance Open Enrollment: Added Healthcare

Health insurance plans change from year to year. Sometimes prices will change, and coverage will change: some things will no longer be covered, and some benefits will be added to your plan. As you look into plans for next year, you might find some newly added healthcare benefits are now included, like telemedicine, which is now included due to the coronavirus pandemic. Telemedicine is just one of the newly added healthcare benefits to look out for in next year’s plans. The Open Enrollment Period is ending in less than 2 weeks, so now is the time to compare plans if you haven’t already.

Benefits To Look For:

Telemedicine

It always seems to happen during the weekend or when your doctor’s office is closed: you or your child gets sick. You then need to consider going to urgent care or the emergency room. The illness might not warrant an expensive trip to the emergency room, and you might want to avoid going to urgent care because of COVID-19. Luckily, with many new plans, you will not have to go to urgent care when an unexpected illness happens. Starting next year, many plans will give you the option to use telehealth to “see” a doctor 24/7 over the phone or on your tablet or laptop, so that you can get the care you need as soon as possible. Check with different health insurance companies to see if they are offering this benefit.

Fitness Benefits

Want to get fit but don’t have the money to invest in a gym membership? Some 0health insurance companies will be offering fitness benefits as part of their plans. These benefits include incentives to get healthier, like paying a certain percentage of your gym membership’s monthly fees. Take control of your wellness, and feel happier and healthier, by taking advantage of this added healthcare benefit!

Chronic Condition Management

Unfortunately, many Americans are dealing with some kind of chronic condition, such as respiratory disease, diabetes, or heart disease. The ongoing treatment for these conditions can become very expensive, because they require constant monitoring and medication. All health plans currently sold on the Marketplace cover chronic care management, but some are limited in what they cover. In general, most plans have some type of coverage for doctor visits, lab tests, prescriptions, preventive care, behavioral health services, rehabilitation services (including physical therapy) and hospital care related to your chronic condition.

Luckily, as of January 1st, some health insurance companies will be expanding benefits for ongoing management of chronic conditions. With some plans, you will be given your own care manager who will work with you to coordinate care and help you manage your condition.

Travel Coverage

Although it doesn’t seem like we will be doing much traveling anytime soon due to the pandemic, the time will come when we will start going on vacations and business trips again, and you might find that you need medical coverage for your trips. Your current plan probably requires you to purchase additional medical coverage before you travel, which most likely costs an arm and a leg. But many health insurance plans will begin to offer travel coverage to members at no extra cost next year. This type of coverage will include:

Medical emergency services: You will receive coverage for medical care such as medical referrals, emergency medical evacuation, prescriptions and more.
Travel emergency services: This will help with things such as lost luggage/documents, and will offer legal and interpreter referrals, as well as care of minor children and pets when experiencing a travel emergency.

Price Estimation Tool

Starting next year, some companies will offer a price estimation tool that will help you budget better for the year. This tool will provide estimates of the price of medical procedures, surgeries, and prescription drugs. It will show you how much in-network healthcare providers charge for services and medications based on your specific plan.

If you are interested in receiving all of these benefits, some of them, or even just one of them, then it is best to compare plans. It can be time consuming and confusing to figure out which plan will offer these benefits, and will also meet your financial needs. EZ.Insure offers free guidance in figuring it all out. We make the process easier by comparing all available plans in your area in minutes. We will compare plans and find one that includes the added benefits you might want/need, but is still in your budget. To get free instant quotes in minutes, simply enter your zip code in the bar above, or to speak to an agent, call 888-350-1890.

Signed Up For A Plan & Regretting It? Let EZ Find You A New Plan

Buyer’s remorse- it happens to the best of us. It can even happen to you after you sign up for a health insurance plan. Now that Open Enrollment has ended and you have signed up for a plan, have you reviewed it and come to the conclusion that you don’t really like it? Maybe you felt rushed or pressured into buying a plan before Open Enrollment ended; whatever the case, know that you don’t have to stick with that plan. EZ.Insure can help you change plans if you live in one of the states that has an extended Open Enrollment. If you don’t live in one of these states, we can help find you another option.

Extended Open Enrollment Periods

The Open Enrollment Period (OEP) is from November 1 to December 15, but some states have an extended OEP. These states are:

California– Nov. 1, 2020 to Jan. 31, 2021
Colorado- Nov. 1, 2020 to Jan. 15, 2021
D.C.- Nov. 1, 2020 to Jan. 31, 2021
Massachusetts– Nov. 1, 2020 to Jan. 23, 2021
Nevada- Nov. 1, 2020 to Jan. 15, 2021
New Jersey- Nov. 1, 2020 to Jan. 31, 2021
New York– Nov. 1, 2020 to Jan. 31, 2021

During this time, one of our licensed agents can help you change plans. We will review all available plans in your area, compare quotes and coverage, and find a plan that meets all of your needs – and we won’t make you feel rushed to choose!

Special Enrollment Qualifying Events

When it comes to health insurance plans, you have two options: a private plan or a Marketplace plan. Private plans, like Marketplace plans, meet all the requirements of the ACA, such as including pre-existing conditions and providing free preventive care. Also like Marketplace plans, private health insurance plans have to be purchased during the Open Enrollment Period, unless you qualify for a Special Enrollment Period (SEP).

two rings on the ends of a paper with the word divorce on the paper and a rip in the middle — *Getting divorced is considered a qualifying life event for a Special Enrollment Period.*

To qualify for a SEP, you must experience a qualifying life event. These events include:

Getting married
Having a baby, adopting a child or placing a child up for adoption or into foster care
Moving
Becoming a U.S. citizen
Leaving incarceration
Losing other health coverage due to job loss, divorce, or aging out of a parent’s plan
Losing eligibility for Medicaid or the Children’s Health Insurance Program (CHIP)
Change in income or household status that affects eligibility for premium tax credits or cost-sharing subsidies
Becoming a member of a Native American tribe

If you have experienced one of these events, speak to an EZ.Insure agent about finding a new plan.

Short-Term Plans

If your state does not offer an extended Open Enrollment Period, and you have not experienced a qualifying life event that would qualify you for a Special Enrollment Period, you still have options. For example, you can look into a short-term health insurance plan. Not only are these plans affordable, but their coverage is flexible. Short-term plans can be sold year round and can cover you for up to a year, which will provide you with at least some health insurance until the next Open Enrollment Period. Or, if you are happy with your short-term plan, you can re-apply for another short-term plan. Although these plans are not required to cover the 10 essential health benefits that ACA plans are required to, they are good options for those who are looking for convenient and affordable coverage.

Catastrophic Plans

If you are under 30 and qualify for a hardship exemption, then you can sign up for a catastrophic plan at any time. Hardship exemption means that due to financial hardship or other hardships, such as the death of a family member, you are unable to afford health insurance coverage. Many people are unaware that these plans are an option. These plans:

Cover all the essential benefits defined by the ACA
Have high deductibles
Cover at least 3 primary care visits per year before the deductible is met (copays can apply for these visits, but part of the cost will be paid by the insurance company, even if you haven’t met your deductible).

Some hardship exemptions include:

Homelessness
Bankruptcy
Domestic violence
Death of a close relative
Utility services being shut off
Eviction
Home foreclosure
A fire or other natural- or human-caused disaster that results in substantial property damage

Beat Buyer’s Remorse

Purchasing a health insurance plan that you later regret is not the end of the world. You still have options. If you live in one of the states with an extended deadline, great! You can purchase a Marketplace plan or private health insurance plan through one of our agents. If you do not live somewhere that has an extended Open Enrollment Period, then consider a short-term plan or a catastrophic health plan. You do not have to stick with the plan you currently have and continue to pay monthly premiums for a plan that doesn’t meet your needs, or is too expensive.

Your best bet? Speak to an EZ agent! Our agents are highly trained in the health insurance industry and work with the top-rated companies in the nation. To see all of your options and find out how to save money, simply enter your zip code in the bar above. We will provide you with free instant quotes within minutes. Or to speak directly with an agent, call 888-350-1890.

How Moving Impacts Your Health Insurance

Whether it’s for a job, to attend school, or just to start a new life, moving is a life-changing event. Changing locations impacts a lot of things in your life, including your current health insurance plan. In many cases, you will not be able to keep your plan if you move. Depending on whether you are moving in state or out of state, you might need to either find a new plan, or take steps to update your insurance company. If you’re planning a move, make sure that you know how to stay properly insured, so you don’t experience any unexpected medical bills.

Moving To A Different State

Health insurance plans vary across the country because plans from different carriers are tied to specific states. Some insurance carriers allow you to keep your plan if you move out of state; others do not. In most cases, even if you are able to keep your current plan, you probably won’t want to. For example, PPO or POS plans allow you to seek medical care outside of your current home state, but if you do, you will be considered out-of-network, and you will have to pay a percentage of your bills. This can be quite expensive; out-of-network care in general is very expensive.

If you’re moving out of state, you’ll most likely need – or want – to get a new health insurance plan. Moving is considered a qualifying life event, so as long as you had coverage for 60 days before your move, you will be eligible for a Special Enrollment Period. This means that you will be able to enroll in a new plan outside of the annual Open Enrollment Period. You will have a 60-day window from the date of your move to get a new plan. Report your out-of-state move to your health insurance company as soon as possible, so that you can enroll in a new plan without a break in coverage.

caucasian hand holding a california state map — *If you move within the same state, then you have to update your insurance company.*

Moving To Another State For Work

If you work for a large employer that has locations throughout the country, and your job requires you to relocate, you might find that your coverage remains the same. Prior to moving, though, you should make sure that your current health insurance plan is offered in the new state; if it is not, you will need to take the necessary steps to get insured. If this is the case, you will qualify for a Special Enrollment Period and will be able to search for a new plan.

Moving Within The Same State

If you move within the same state, odds are that your coverage options won’t change. You will have to update your address with your insurance company; while you’re contacting them, it would be a good idea to check if there are any different plans available in your new location that could save you money. As long as you have moved to a new zip code, you will still qualify for a Special Enrollment Period.

When Your New Plan Will Begin

the number one surrounded by a red square. — *When you sign up for a plan before the 15th, it will begin on the first of the next month.*

Whether you are moving out of state or somewhere within the same state, you should take advantage of your Special Enrollment Period and look for an affordable plan. As soon as you get your new address, sign up for a new plan as quickly as you can – otherwise, you might have a gap in coverage. Try to enroll in a plan in the first half of the month if you can: if you enroll between the 1st and 15th of the month your new plan will start on the first day of the next month. If you apply after the 15th, then your new plan will not begin until the first day of the second month after you enrolled.

Packing up your whole life and moving house is very stressful and expensive, and health insurance is probably not at the top of your list when you’re getting ready to make such a huge life change. Instead of worrying about your plan options and doing all the researching and comparing on your own, let us take the burden off of you. EZ will instantly compare plans for the new address you are moving to in minutes. Our services are always free, so you won’t have to worry about spending any extra money.

We want you to focus on getting to your new destination, so we’ll find the best insurance plan for you while you worry about your move. We will assess your needs and find a plan with the most coverage and the most savings. To instantly compare quotes, enter your zip code in the bar above, or to speak to one of our licensed agents, call 888-350-1890.

Tag: health insurance help