LOOKING FOR INSURANCE FOR YOURSELF OR YOUR FAMILY?
Here are a few things we think you should consider:
Which type of plan will work best for your needs?
(HMO)
Health Maintenance Organization
HMOs generally require you to choose a primary care physician (PCP) who coordinates your healthcare and provides referrals to specialists within a network of providers. Some HMOs require you to see your PCP before a specialist visit will be covered.
HMOs do not offer out-of-network coverage, and most plans will not cover you out-of-state unless you have a life or limb threatening event.
HMOs typically have lower monthly premiums and out-of-pocket costs but less flexibility in choosing providers.
(PPO)
Preferred Provider Organization
PPOs offer more flexibility in choosing healthcare providers. They offer in-network and out-of-network coverage without needing referrals from a PCP. This includes coverage when you're out of state.
PPOs typically have higher monthly premiums and out-of-pocket costs. You pay for the convenience of healthcare.
(EPO)
Exclusive Provider Organization
EPOs are similar to HMOs but do not require you to see a PCP before a specialist. They do not offer out-of-network coverage, but they tend to have a larger network than an HMO.
EPOs offer lower monthly premiums than PPOs but are typically more expensive than HMOs.
Catastrophic Health Insurance
Catastrophic plans have very high deductibles and are designed to cover worst-case scenarios. People enrolling in these plans typically pay cash for basic/preventative health services and want the lowest monthly premium possible.
To qualify for a catastrophic plan, you must be under 30 years old or qualify for a hardship or affordability exemption.
Short-Term Health Insurance
Short-term plans provide temporary coverage for gaps between other health insurance plans, such as during job transitions.
We also use these plans to keep people insured if they missed open enrollment and don't qualify for a special enrollment period.
Short-term plans typically have limited benefits and are not renewable.
Are your doctors and medications in-network?
Ensuring that your preferred doctors and medications are covered in-network is crucial when selecting a health insurance plan. In-network providers have pre-negotiated rates with your insurance company, which means you will pay less out-of-pocket for visits and treatments. Moreover, out-of-network care can be significantly more expensive and may not be covered at all. Checking if your current medications are included in the plan's formulary is also essential to avoid unexpectedly high costs or the inconvenience of switching prescriptions. We discuss preferred doctors and medications with every potential customer and help them choose a plan that includes their trusted healthcare providers and necessary medications, guaranteeing better continuity of care, peace of mind, and substantial cost savings.
What are your out-of-pocket costs?
Understanding the various components of health insurance is essential to making informed decisions. Deductibles are the amount you must pay out-of-pocket before your insurance starts covering costs for services UNLESS your plan offers pre-deductible copays. Copays are fixed amounts for specific services like doctor visits or prescriptions. Coinsurance is your share of the costs for services, calculated as a percentage of the total charge after meeting your deductible. Finally, the out-of-pocket maximum is the most you'll pay in a policy period (usually a year) for covered services, including deductibles, copays, and coinsurance. After reaching this maximum, your insurance covers 100% of eligible expenses. These elements work together to balance your upfront costs and potential expenses throughout the year.