Whether you are shopping for yourself, your family or your business,
Ask Yourself These 6 Questions Before you Buy
Purchasing health insurance based on a lower monthly premium alone may actually cost you money annually. Our brokers not only shop prices and plans from all carriers, but explain how the plan details benefit your needs most. We also explain to employers what options and requirements are available to help your bottom line while still offering quality coverage to your valuable employees.
Premium aside, what could you afford upfront for Dr. visits, surgeries, hospital stays, or emergencies. Coinsurance, copays, deductibles and out of pocket expenses must be considered.
If you prefer a specific doctor or hospital, ensure they are in your network. Clarify if your plan pays if you do go out-of-network or if those costs count toward out of pocket maximum.
Lower premium & higher cost for care or higher premium & lower cost of care
Small or Large provider network
20% to 50% Coinsurance
Size of copay for prescriptions / visits.
Each carrier has their own list of covered medications. Research how your plan pays for your current generic / name brand and / or specific medications you may need.
If you rarely utilize services and are healthy, the Bronze plans may be a good fit. If you plan a surgery or have a medical condition, a Gold plan may be more beneficial in the long run.
Plan out any routine or upcoming services you or a family member may need and understand how those wold be paid. Remember preventative services are usually free.
WHAT CAN I AFFFORD?
WHAT IS MOST IMPORTANT TO ME?
HOW OFTEN DO I SEEK CARE?
WHERE DO I GO FOR CARE?
ARE MY PRESCRIPTIONS COVERED?
WHAT SERVICES WILL I NEED?
Understand how the plan works. Example: How a Silver Plan with a 2500 Deductible and 30% Coinsurance works toward your annual out of pocket maximum.
For most plans, you will pay a copay for regular doctor visits and prescriptions at the time of service. Some services you will pay for 100% until your deductible has been met.
Once you meet your $2500 deductible for covered healthcare services and prescriptions, (not including copays). You pay 30% and your insurance pays 70%, however copays will continue.
Once you meet your out of pocket maximum for covered services and prescriptions, in most cases you pay $0 and your plan pays 100% of covered benefits for the remainder of the year.
<<< Copays generally do not apply toward deductible, but do apply toward out of pocket maximum >>>
Understand Plan Key Elements
Metal Tiers (Coverage Levels)
With the inception of the Affordable Care Act, health plans have been organized by metal levels, Platinum, Gold, Silver and Bronze, to help consumers narrow options. Generally, the higher the "Metal level", the higher the premium, the lower you pay for cost of care and vice versa.
Copays are usually a predetermined rate you pay for health services at the time of care. For example, your plan may provide a $20 copay for doctor visits, a $10 copay for medication and a $250 copay for an emergency room visit. Copays generally do not count toward your deductible, but do count toward your annual out of pocket maximum.
Coinsurance will begin when you have met your deductible. Your insurance plan will now split the cost of insurance services, not subjected to copays. If you have 30% coinsurance, you will pay 30% of services and your insurance plan will pay 70%.
The premium is the amount you pay monthly, whether you use insurance services or not, simply to keep your policy in place. Premiums are no longer based on pre-existing conditions, but are based on age, where you live, whether you use tobacco (individual plans only) and the coverage level of your plan.
Metal Tiers (Coverage Levels)
The plan deductible is the amount you pay before the plan begins to pay for services. Certain services such as doctor visits and prescriptions are not subject to the copy and do not count toward your deductible but do count toward your out of pocket maximum.
Out of Pocket Maximum
The out of pocket expense is the maximum dollar amount that you will pay annually for covered expenses under your policy, including deductibles, coinsurance and copays. After this dollar amount has been reached, all eligible medical bills will generally be covered 100% by your plan.
Other items for individuals to consider
Are you married, is your spouse or domestic partner on a group plan. Are you in a common law relationship. Are your children young or in college. Has your income changed in the past year. Has your family size changed. Do you travel frequently. Is an HMO, PPO or an HSA the best fit for your needs.
Do you own a small business
There are numerous differences and benefits if you own your own business and have at least one employee on payroll...
"Health Shop has been an invaluable resource and has made such a difference! With their help we have even been able to incorporate dental and disability policies. We are grateful for their hard work and caring attitude, we highly recommend Health Shop brokers."
"Over the 5 years that I have worked with Health Shop, I have found the staff extremely friendly and helpful. It's refreshing to speak to a live person and have emails returned right away! My agent contacts me well before my renewal and explains the best options for the company and the employees. I strongly recommended Health Shop to any business."
"A friend of mine referred me to Health Shop nearly 8 years ago. I was pleasantly surprised at how informative and friendly Ron was when explaining my options. He helped me with all the paperwork and I had a policy in place within 2 weeks. It is my pleasure to recommend Health Shop to anyone that is considering their services."