In the ever-changing world of healthcare coverage options, it can be confusing to know what's available, what's affordable and what's best for you/your family. Our goal is to look at your individual situation and match you with the plans and/or programs that best suit your needs.
• HMO's or Health Maintenance Organizations usually limits coverage to care from doctors who work for or contract exclusively with the HMO. Most do not cover any out-of-network expenses except for emergencies.
• EPO's or Exclusive Provider Organization are a managed care plan where the only coverage you have is within it's network of doctors or hospitals. These are typically smaller networks of coverage.
• PPO's or Preferred Provider Organizations are the most flexible of the major four plans. Normally you can use doctors, hospitals and providers within and outside the network. You may receive additional savings for staying within the network.
• POS's or Point of Service is a plan which where you save money by staying in the network you are in but you can get referred outside of the network for a larger fee.
• Discount Plans
Discount plans do just that, provide a network discount. This plan will only offer you a discount on medical bills or services you incur while using their network.
• Health Sharing Plans
These faith-based plans or programs allow members to voluntarily contribute and share medical expenses with all members for eligible medical expenses. Members pay a monthly premium which are distributed among members to pay for medical bills. These plans are not, however, health insurance. and may have limitations for some typical medical costs.
• Short Term Health Insurance
This type of insurance provides coverage for a defined period and generally has a much lower monthly premium than other forms of major medical health insurance. These plans do not usually require an enrollment event and last from 30 to 90 days. You do need to re-apply for these plans each time your coverage term expires and there usually is a renew fee each time. They do not cover any pre-existing conditions.
• Guaranteed Issue Plans
If you have a qualifying life event, you have the availability to choose from ACA/Obamacare.Marketplace Plans. ACA policies that are guaranteed are great for those who have significant health issues such as heart attack, stroke, cancer. Diabetics also are a key group for these plans because they can still obtain coverage without worrying about their pre-existing conditions. These plans normally cost much more if you do not qualify for a subsidy because the price is based on the health of a geographical location and not on the individuals being covered.
• Medically Underwritten Private Plans
Approval-based or underwritten plans provide an option to lower rates and increase benefits since the insurance company is taking a much smaller risk on the individual that has been underwritten. With this policy, the insurance company can be selective on their applications which means you must be medically underwritten and approved before you're eligible for the policy.
• Employer Plans
Plans through an employer are normally guaranteed issue plans; meaning you do not have to qualify medically and they do pay on any pre-existing conditions. Employer plans have changed in the last few years and often pay for the employee but it’s very costly to add on dependents. In such cases, we sometimes split the family coverage to make it more affordable and still allow everyone to be on a quality plan.
• Deductible
A deductible is an amount you must pay (besides your monthly premium) before any medical benefits kick in.
• Out of Pocket Maximum
The out of pocket maximum is the amount you are liable for in the year for your individual/family medical bills. This is also called a stop loss.
