General Health Questions

How do you go about choosing the right health insurance plan? There are a number of things you need to take into account before buying.

How many times do you visit a doctor all year?

What is your current health status?

Do you need catastrophic protection only?

Do you need doctor office visit co-pays offered before your deductible?

Would you like prescription drug co-pays?

How much of a monthly premium can you afford?

Are you someone that visits the doctor frequently? If yes, then you’ll benefit from having the office visit co-pay before having to satisfy your deductible. Without co-pays the visit could potentially cost anywhere from $85 to $150 for a sickness checkup. Also with a co-pay plan you’ll pay anywhere from $10 to $50 per visit. Keep in mind the office visit co-pay will add to your monthly premium. That’s why we ask how many times you go to the doc per year. If you go only once, then you should consider the catastrophic coverage. What’s the point in paying for benefits that you aren’t going to use?

Being healthy and staying in good health is critical to getting approved at the best rate. Most insurance carriers look for individuals and families that are healthy. Also with a carrier like Aetna you may get approved at three different rates, A, B or C rating. The A rate is the best rate available for that particular plan. The B rate is your original (best) rate plus 25 percent and the C rate is your original (best) rate plus 50% of the premium. Carriers have the right to raise your monthly premium based on your health conditions, or they can possibly decline you. That’s why it’s beneficial to be in good health when applying to all health insurance companies. It’s not impossible to get health insurance if you’re taking over two medications however it can get a little pricey. For clients that are declined there’s always the say sponsored MRMIP coverage for states such as California (check within your say to get the full details of what say plans are available. The Major Risk Medical Insurance Program (MRMIP) is a funded by tobacco taxes, sometimes there may a shortage of fund resulting in the individual being put on a waiting list. Generally this waiting list is a maximum of 3 months.

If you know that you only need catastrophic health protection then you should take a look at the health plans without office visit co-pays. The catastrophic plans usually give you the benefit of getting a physical once per year at a co-pay or for almost free of charge. However, that’s the only co-pay benefit you receive before satisfying your deductible. After you determine that you need catastrophic protection you need to consider your maximum out of pocket. The out-of-pocket maximum is the maximum amount of money you’ll have to pay in a calendar year. Let’s say your out-of-pocket max is $3000 for a calendar year. If you go to the emergency room and are then admitted to the hospital for three days, chances are your claims will be very high (potentially $50,000, $60,000 or even $100,000.) If you need a surgery or some other type of emergency service your claims could reach $400,000. Also with an insurance plan that has a maximum out of pocket of $3000, you’ll only pay $3000 for those high claims that could leave you bankrupt. Make sure to pay attention to your out of pocket maximum. That is the main reason for insurance in the first place.

Like office visit co-pays, you can choose to elect co-pays for your prescription drugs. On the average you’ll have a $10 co purchase generic and a $35 co-pay for brand drugs (there is usually a brand deductible applied ranging from $250 -$750). Some plans will come with generic prescriptions only and/or have a maximum cap put on the Rx benefits. This is common with the new lower priced premium plans. Unfortunately the insurance carriers can’t offer the full prescription drug benefit plans at a affordable monthly premium like they used to. People take a lot more prescriptions now and they cost a lot of money for the carriers annually. Make sure a pay close attention to what type of prescription drug coverage you’re getting on the affordable premium plans. If you take two to three prescriptions and really need good drug coverage then you’ll pay a little more in premium but save a lot in the long run.

Lastly after you’ve answered the other five questions, you need to decide how much you can afford monthly. The higher the benefits on your plan the more it’s going to cost. It’s the same with car insurance, full coverage or liability only. There are low deductibles, high deductibles and zero deductible health plans. As a general rule of thumb, the lower your deductible the higher your monthly premium will be. To narrow down a plan that works for your lifestyle it is always a good idea to speak to a local insurance agent. An agent will quickly get a sense of your insurance needs and then browse each insurance carrier to find a plan that’ll work for you based on benefits, needs, out of pocket maximum and monthly premium. If you go directly to the insurance carrier your options will be limited to only that carrier.

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