Each American’s situation and circumstances is different. The best thing we can tell you is that we are well-versed in the industry, study it closely, and have the best companies to represent in the industry. See your Cool Agent for more information and he/she will be happy to help you.
Individual plans are usually one of two types;
PPOs (Preferred Provider Networks)
- A type of health insurance arrangement that allows plan participants relative freedom to choose the doctors and hospitals they want to visit, usually from within the plans “network of providers”.
- Obtaining services from doctors within the health insurance plan’s network, called “preferred providers”, results in lower fees for policyholders; however, out-of-network doctors are still covered.
- Coverage under a preferred provider organization (PPO) requires ongoing payment of premiums by policyholders to the insurance company.
HMOs (Health Maintenance Organizations)
- An organization that provides health coverage with providers under contract with the plan.
- A Health Maintenance Organization (HMO) differs from traditional health insurance by the contracts it has with its providers.
- Plan participants usually begin with their primary care physician (PCP) and from him/her receive referrals to see specialists.
- Participants must be careful to make sure that providers and services are covered under the plan and generally it is wise to consult with the plan adminstrators to “pre-authorize” procedures and visits.
- These contracts allow for premiums to be lower, because the health providers has the advantage of having patients directed to them; but these contracts also add additional restrictions to the HMO’s members.
Other Plan Features to Shop Carefully
You need to know what the deductibles, Co-pays, and Coinsurance are for the plan you are shopping.
The amount you have to pay out-of-pocket for expenses before the insurance company will cover the remaining costs. The lower the deductible, generally, the higher the premium for the plan. Sometimes, higher deductible plans come out having a lower annual cost than lower deductible plans, and visa-versa.
Generally an amount that you pay, off the top, each time you see the doctor or receive services. Frequently “co-pays” can run $20-$50 for each visit to see a PCP, an ER visit might be $65, and so forth. These minor charges are paid each and every time you receive treatment. Kind of the plan’s way of making sure you have skin in the fight and are not just running in to see the doctor for no reason whatsoever
Once your deductible is met, your plan will pay a percentage of your eligible health expenses. The amount remaining after your insurance company pays is called coinsurance. Coinsurance is your responsibility to pay and it can add up quickly if you are not careful. This is where a lot of people get “got”. Imagine your plan is an 80%/20% split and you come down with some major illness like cancer (God forbid it should happen and we are not wishing that one anyone), but, for illustration, let’s say you came down with Cancer and you run up a $100,000 medical bill. Well, your insurance would pay $80,000… leaving you still to pay $20,000 for your treatment. Ouch.
OtherFactors That Can Affect Your Premium Rates
Age, Sex, Size of Family, Family Medical History, Lifestyle, Habits (smoking, drinking, etc) – A lot can affect your quoted rates. Be sure to see your Cool Agent and let them help you get the best quote.