When it comes to health insurance, most people don’t even think about getting it until they need it. This is because most people are fixated on how expensive health insurance can be. Choosing to wait until you need it rather than getting it while you’re healthy and being prepared can have some serious consequences. What if you get into an accident and don’t have health insurance? If you need surgeries or medical care then you’re stuck footing a pretty massive bill entirely out of pocket. Large medical bills can even bankrupt you! This is just one of many reasons you need to get health insurance sooner rather than later. Below we’re going to look at all the benefits of being prepared for unexpected medical emergencies with health insurance.
Free Services
Let’s start simple, health insurance doesn’t just help you pay for medical bills. It also comes with free benefits built into your plan that help keep you healthy and can help prevent some of those medical emergencies. Typically, your health insurance plan will offer free services such as:
Annual physical exams
Routine blood work
Cancer screenings
Blood glucose tests
Vaccines
Blood pressure monitoring
Blood cholesterol monitoring
These services might seem unnecessary when you’re healthy, but if you’d like to stay that way they’re important. These free services help catch diseases and medical conditions before they’re critical (or fatal). The earlier you catch health complications the easier it is to get treated and back to normal. If you hold off on health insurance you could end up sick without care and unnecessarily have to suffer through symptoms when a quick trip to the doctor could have either prevented it or given you symptom relief immediately.
Health Insurance Saves You Money
Health insurance doesn’t just protect your health but it also actually protects your bank account. We know what you’re thinking, “How would it save me money when I’m paying so much money for a premium?”. By having an insurance plan you’ll actually have less out-of-pocket healthcare costs, since your plan will cover significant portions of your medical costs. Not to mention, staying healthy keeps your healthcare cheaper. Consider for a moment how much you would have to pay out of pocket for an unexpected medical emergency. Medical bills can easily cost hundreds to thousands of dollars.
Take a broken arm for example, a simple fracture that doesn’t need surgery can cost about $2,500 without insurance,but with surgery that fracture goes up to around $16,000. That’s a lot of money for just one medical emergency. Not to mention health insurance itself is actually cheaper to buy when you’re healthy because you’re not as much of a risk to insure.
Staying On Top Of Medical Conditions
Unfortunately, many Americans suffer from a disease like diabetes, hypertension, high cholesterol, COPD, or even cancer. Even the healthiest person can suddenly develop a disease, especially if it’s hereditary. You need healthcare in order to control or prevent them from getting worse. Some diseases if left untreated can also start to cause you to develop other illnesses or compromise your immune system, making it harder for you to fight off even the slightest illness like the common cold. Without health insurance, prescriptions, treatments, doctor visits, and hospital stays that are linked to a medical condition can cost tens of thousands of dollars. Your health insurance makes sure that you don’t go broke while trying to care for these health problems.
In addition, the Affordable Care Act requires Marketplace plans to cover pre-existing conditions. This means that even if you already have a diagnosis, you can’t be denied coverage or charged extra just because you have a condition. Since you’ll have access to all the care you need, your health insurance plan helps manage your care for any chronic illnesses you have.
Family Planning
If you plan to start a family, even if it’s not anytime soon, health insurance is a must. Having health insurance before starting a family gives you access to maternity appointments, vaccinations and hospitalizations you’ll need throughout yours or your spouse’s pregnancy. Medical costs linked to pregnancy can easily reach $10,000 and higher. Not to mention, it’s so much easier to simply add your newborn to your existing health plan. Your new baby will immediately have health insurance and you’ll never have to worry about pediatrician bills. Plus as children age they tend to need a lot of healthcare, they can get hurt or sick easily while their immune systems develop, especially once they hit school age. Trust us, flu season is no joke for kindergarteners, you don’t want to be caught without health insurance when it hits.
Protects You Between Jobs
If you get health insurance through your employer, then unexpectedly losing or having to leave your job can be difficult. When you stop working there, you lose all those health benefits as well. Nonetheless, it doesn’t have to be hard. If you lose your job you may actually qualify for a Special Enrollment Period, so you won’t have to wait for the annual Open Enrollment Period to enroll. This ensures you don’t have to go months without coverage.
Another option for small gaps in coverage are short-term health plans. Instead of enrolling in a year-long plan, short-term health plans give you access to health insurance for a few months to make sure you’re always covered, even if you only need it for a little while. They are inexpensive and provide all the essential health benefits during the policy. However, it’s important to note every state handles short term health plans differently. State’s have their own guidelines about how long you can have a short term health plan, and some state’s don’t even allow them to be sold. To learn more about how short term health plans work in your state check out our state by state health insurance guides here
Which Plan Is Best For You?
Let’s take a look at your options for health insurance plans. There are so many options you’re sure to find one that works for you and within your budget. With health insurance there are two main decisions you need to make, which plan type and which metal tier you want.
Plan Types
HMOs, PPOs, EPOs, and POS plans are your main types of health insurance. Don’t worry we’ll explain the alphabet soup below. The type of plan you select will determine what your out-of-pocket costs are as well as what your provider options are.
This type of health plan typically restricts your coverage to care from their in-network providers. It will only cover out-of-network care during an emergency. They also usually require you to live within their service area. Don’t worry too much about the service area, there’s plenty of companies to go around, no matter where you live you’ll find a plan. With an HMO you select a primary care provider (PCP) who will coordinate all of your care and provide referrals to specialists when you need them.
Just like HMOs, PPOs have a group of contracted doctors and providers that make up their network. However, with PPOs you do also get some coverage for out-of-network care as well. Although, seeing in-network providers saves you more money since your plan will cover more of these services. PPOs don’t require you to choose a PCP the way HMOs do and you don’t need referrals to see specialists. So, you’ll be in charge of coordinating all of your own care with this plan.
Exclusive Provider Organizations (EPOs)
EPOs also provide you with access to a network of participating providers, with the exception of emergency situations, the majority of EPO plans do not cover out-of-network care. You may or may not be required to choose a PCP, based on your plan. In either case, you do not need a referral from your PCP to see a specialist within the plan’s network.
Point-Of-Service (POS)
POS plans combine PPO and HMO characteristics. Similar to an HMO, the provider network for a POS plan is typically smaller than that of a PPO plan, and similar to a PPO plan, in-network care expenses are typically less expensive. In POS plans, you must choose a primary care physician (PCP) from the network of physicians and other primary care specialists. If you have a POS, you must obtain a referral to see a specialist. However, similar to PPO plans, you have the option of seeing either in-network or out-of-network specialists. However, if you visit an out-of-network provider, your portion of the costs will be higher, and you will be responsible for submitting claims.
Metal Tiers
Since The Affordable Care Act went into effect in 2010, traditional health insurance plans are generally purchased through the Marketplace. When you buy a plan through the Marketplace they are separated into 4 categories: Bronze, Silver, Gold, and Platinum. The plans in these tiers are categorized based on their price and how much of your health care you are responsible for vs. how much your health plan pays for.
Bronze
Bronze plans have the cheapest monthly premiums but the highest deductibles and out-of-pocket costs. With a Bronze plan your insurer covers 60% of your medical expenses and you’re responsible for the remaining 40%. Bronze plans are a good option if you don’t use medical services frequently but need a low-cost plan to protect yourself against severe illness and injury. Since the deductible and cost-sharing percentage are both relatively high, you’ll be responsible for the majority of your care.
Silver
Plans at the Silver tier have moderate monthly premiums and out-of-pocket costs. These plans cover 70% of your medical expenses, while you are responsible for the remaining 30%. These plans are an excellent option for those who are willing to pay a bit more to have more of their routine care covered.
Gold
Although Gold plans have high premiums, the out-of-pocket cost of care is lower than that of higher-tier plans. These plans have low deductibles, and your plan will cover 80% of your care while you pay 20%. If you require extensive medical care, a Gold plan may be a suitable option, as it will cover more of your expenses.
Platinum
The Platinum tier has the highest monthly premiums of all the tiers. However, despite the high premiums, your out-of-pocket expenses will be the lowest of any plan type, and your insurer will pay more of your expenses throughout the year due to the extremely low deductibles. Due to the fact that these plans cover 90% of your medical expenses, they can be a good deal for those in need of numerous medical services.
Get Insured Today With EZ
Although health insurance may appear expensive, it is important to evaluate a plan’s value and how much you will save over time. When comparing the overall cost of health insurance versus the cost of a medical emergency without coverage, it pays to have protection. In the event of a medical emergency, the last thing you want to worry about is finances. Knowing that your loved ones are protected and can seek care, rather than attempting to “ride it out” due to lack of insurance, is priceless. Speaking of priceless, EZ.Insure can help you compare every plan available to you and make sure you stay within your budget, and we do it all for free! To start, simply enter your zip code into the bar below to get your free instant quotes or give one of our licensed agents a call at 877-670-3557.
Insurance is a huge part of our daily lives, and when you get a new plan you are flooded with forms and contracts. But do you really know what all the forms are and what they mean? One form, the most important form is your insurance contract. This is an important piece to be familiar with because it’s the main document you reference whenever your policy is brought up. It’s the main source of information describing your obligations and your insurance provider’s.
Make sure you’ve read everything thoroughly. You don’t want any surprise fees down the line.
It doesn’t take long to understand this document. We’ll get you up to speed in no time at all.
Know Your Terms
Probably the quickest way to lose someone is to speak in insurance lingo. For someone outside the industry, the lingo can get confusing. Here is a general list of broad insurance terms to get you on the same page:
Beneficiary– a person named in a policy that receives the benefits
Policy Owner or Holder– person who holds the plan
Premium– the amount paid to the insurance company to keep the policy valid
Deductible– the amount you pay out-of-pocket every year before the insurance company begins assisting
Carrier– the insurance company providing your policy
Claim– a formal request for benefits by the insured to the carrier
Everyone’s contract will be a little different, depending on the policy type. Your document should have a list of definitions in it describing what they mean.
Declarations Page
The first step anyone will tell you is to locate the declarations page and read that first. Fortunately, it comes before anything else in the insurance contract and has an overview of both the policy and you as the insured. If you’re looking for specifics, on the declarations page, you’ll find:
Who or what is insured
How long the policy will provide coverage
The deductible
The plan’s dollar limits
Your expected payment (premium)
When your payments are due
If you’re looking for answers, the declarations page is the place most likely to have them. General policy and payment details are contained therein and should be formatted to be easily read.
If you’re not sure about something, look it up. You don’t want to misunderstand an important term.
Insuring Agreement
This is the meat of your contract as it covers everything the carrier will be responsible for. After you’ve familiarized yourself with the terms and oriented yourself with the declarations page, this portion will give you the in-depth look at what benefits you’ll receive from your policy.
There are two distinct types of insuring agreements that you should be aware of:
Open Perils Coverage– Previously known as “All Risk” the name was changed in the industry recently to clarify that it does not actually protect from “all” risks. This plan covers everything except for exclusions named in the contract.
Named Perils Coverage– This policy type is much more specific and details each loss that the carrier will cover, rather than state only exclusions.
You’ll find both policy types outlined considerably in this section as the carrier wishes to keep everything as clear as possible. Coverage definitions are specific for a reason.
Exclusions & Modifications
These are grouped together as the side-dishes if we’re sticking with the food metaphor. Exclusions are detailed examples of what the carrier will not provide coverage for in the policy while modifications (or endorsements) are the alterations made to the original contract. Here are examples of both exclusions and modifications:
Exclusions:
Theft exclusion
Freezing pipes and systems in a vacant property
Settling, wearing of property
Government actions
Modifications:
Additional storm coverage
Home business coverage
Detailed property item coverage (valuables or otherwise)
Conditions
Lastly, you should review the requirements to maintain your coverage. After taking note of everything in your contract, you don’t want to miss out on benefits because you failed to meet the conditions outlined in the document.
There are professionals in the industry waiting for your calls. Don’t hesitate to ask for help.
These are actions you as the insured must take to keep your policy valid. For example, one popular condition added to most contracts involving property is to notify the police once the damage is done. If you haven’t filed a police report, or have the report handy for the insurance company, then your carrier can consider you breaching their contract, and will withhold the benefits you need to get your home or business up and running again.
Once you have all these checked off your list, you should have a well-rounded idea of what your policy will cover and how to keep it. Important details from the contract should be noted separately or highlighted on your copy(like premiums and exclusions) so that you can easily reference them later.
As always, EZ.Insure is around to assist with your insurance needs. Your agent will answer any questions you have, compare different plans for you, and even sign you up when you’re ready, free of charge and without having to worry about being hounded by endless calls. To get started simply enter your zip code in the bar above, or you can speak to an agent by emailing [email protected], or calling 888-350-1890. EZ.Insure makes the entire process easy, and quick.
Once you sign up for a health insurance plan, you are immediately expected to start monthly premium payments. Then, if you incur medical expenses such as lab work, you are expected to pay these expenses, contributing to your ‘deductible.’ A deductible is an amount you have to pay before your insurance starts paying a percentage. Then, once you are finally all caught up with your deductible, your insurance policy covers the rest of your claims, right? Well, kind of, unless your policy has a coinsurance clause.
Once your deductible is met, any insurance-covered procedure, treatment or service will result in a medical expense. This is called coinsurance. Your insurance company will pay a large portion of any bill (after your deductible is met), and you are responsible for the rest. There are different breakdowns for how the coinsurance is paid for.
Coinsurance is a great option for people needing a little extra help.
How It Breaks Down
The divisions in coinsurance policies are usually broken down into 70/30 or 80/20. What this means is the insurance company will pay 70% or 80%, and you will pay the remaining 30% or 20% out of pocket. The most common coinsurance breakdown is 80/20.
This will only apply once your deductible is met. If you have a $1500 deductible, then you must pay this off first before activating the coinsurance.
Now, let’s use an example. If your medical bill is $2,000 and you have a $1,000 deductible, then the portion of the bill that the coinsurance will apply to is $1,000. With a 20% coinsurance, you will pay $200 extra. In total, the $1,000 deductible plus the $200 remaining of the coinsurance will equate to $1,200 out of pocket.
Now if your deductible was already met and you had that same procedure that was $2,000, then you would have to pay 20% of it. The sum total of $400 out of pocket, since the insurance company paid $1,600 of the service.
Out-of-Pocket Maximum
Now, to throw a wrench into things, health insurance companies offer plans with an out of pocket maximum- but this will work in your favor if you have coinsurance. Once you reach your out of pocket maximum, then the insurance company will pay for any following services 100%.
For example, if you have a $5,000 out of pocket maximum, then the $1,000 deductible you paid goes towards that. This leaves you with only $4000 left to pay. Every 20% or 30% you pay in coinsurance goes towards your out of pocket maximum.
If you have surgery that costs $20,000, then you will have to pay a 20% coinsurance of $4,000. Once you pay that off, including the previous $1,000 deductible, then you can not be charged for anything further out of pocket. The out of pocket max will have been satisfied and the insurance company must pay any following services fully.
Think of the money you’ll save by using this insurance method–paying completely alone could be devastating.
Because policies are renewed annually, once the new year begins, then your deductible restarts, and you will have to meet that price again. Some people have to deal with coinsurance, while others just have to pay their deductible and the insurance company will pay the rest.
In order to find a plan that meets your budget, and needs, speaking with an agent will help. They can help guide you in the best direction, and explain to you thoroughly how much everything will be. You can discuss with them coinsurance, and if you would like a plan that has one or doesn’t. To speak to one of our highly trained agents in your area call 888-350-1890, or email us at [email protected]. Or to get instant quotes, enter your zip code in the bar above. Health insurance has so many different variables. Let us make it more simple and easy for you.
