FAQs
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It depends.
Ugh – what a frustrating answer. But it’s true. There are so many factors when determining the cost of health insurance that it would be wrong for me, or anyone for that matter, to just “give you a quote”.
Shopping health insurance by cost is a good way to get a product that fits your budget, but not necessarily your health care situation. You may find that when disaster hits, your coverage is lacking and leaves you with a bill you can’t afford. By determining what’s important to you and your family, we can arrive on the right plan – and then factor in cost.
Here are some questions that will determine the right coverage for you:
How many people need coverage? How old are they? What’s your household income? Does anyone smoke? Do you need mental health coverage? Does anyone intend to become pregnant? Does anyone receive treatment for a condition? How often are you seeking health care? Do you travel a lot? Do you want dental or vision? Which insurance do your doctors accept? How much risk are you willing to take? How long do you need coverage?
Answering these questions will lead us to the right plan at a cost that works for you.
It depends.
Frustrating trend starting here, eh? But really, for some people it is exactly what they are looking for. It’s familiar, convenient, and has the most extensive coverage. Other people are looking for exactly the opposite; they see the high price tag and high deductibles that are characteristic of these plans and want an alternative. Let’s sort this out.
The term Major Medical came in 1948, and it described a plan that only covered major medical expenses. Hospitalization. Disease. Accidents. Surgeries. The “little stuff” was meant to be paid out of pocket. Doctor visits. Ear infections. Dental. Vision. Prescriptions. Minor surgeries.
But over the years, as more specialists, procedures, and treatments were introduced to medicine, insurance companies began to expand these Major Medical plans to cover more things. They also started to cover the little stuff. This broader coverage was nice for some people who used the health care system a lot. But broader coverage also meant increased premiums.
The term Major Medical also no longer applies; it’s been replaced since the passage of the PPACA with the term “qualified health plan”. A QHP must include coverage for the “ten essential benefits”. Some of these are: maternity, drug/alcohol abuse and rehab, pre-existing conditions, mental health. For some people, these benefits are important; and those people should lean to a QHP. For other people, they want to cut out coverage for the little stuff and the benefits they’ll never need. They are looking for a QHP alternative, more closely resembling what the “Major Medical” from 1948 intended.
A premium is the amount of money you pay an insurance company to take on the financial risk of protecting something of value. Your premium is calculated by what you want covered, how much you want it covered for, and what the likelihood of the insurance company having to payout (risk).
A co-pay is a fixed amount of money you pay for a specific service. This could be for a doctor visit, prescription drugs, ER visit, specialist visit, or more. If your insurance includes co-pays, you will be responsible for paying that amount when you use that service, and the insurance company will cover the rest of the bill.
Example:
Your insurance company is XYZ insurance. Your plan says you have a primary doctor co-pay of $40. Dr. Johnson is “in-network” with XYZ insurance and is accepting new patients. You schedule an appointment to see Dr. Johnson in two weeks so she can become your primary care doctor. After your appointment as you’re leaving, you stop at the front desk and pay $40, since that is your primary doctor co-pay. XYZ insurance will pay Dr. Johnson the remainder of the bill. You will not be charged any additional amounts, unless Dr. Johnson has determined you need more health care.