Are you tired of the high premiums and deductibles offered by traditional insurance plans?
Do you avoid seeing a healthcare provider because you don’t know how much you’ll have to pay?
Do you not have health coverage because of the high cost and low value it offers.
In this blog, we want to help you be an informed consumer of your healthcare coverage. Like any other product or service you buy, you should know the options, prices and pros and cons of what is available to you. At Gordon Health Group, our main job is to educate people to help them make an informed decision when they purchase health coverage and services. We know it’s a big investment, so we want you to make a decision that is right for you. Let’s look at the three main types of health coverages available.
Traditional Health Insurance plans purchased through Healthcare.gov or employer
These plans offer co-pays, co-insurance, and deductibles as the basis of the coverage, requiring policyholders to share in the cost of their medical services. Premiums increase with lower copays, co-insurance and deductibles.
Who fits this plan?
Traditional insurance plans are generally right for people who have chronic health issues, requiring ongoing medical services, procedures and expensive medications. Most expensive medications aren’t covered by these plans. Manufacturer coupons are available to help people on traditional insurance plans lower their out-of-pocket costs.
For people who don’t like change, we recommend they stick with a traditional health insurance plan.
Also, these plans are of prime consideration for people who are eligible for subsidies and cost reduction savings based on income and household size. Subsidies can make these plans very affordable and cost reduction savings can offer better coverage through lower copays and deductibles. A policyholder must monitor their actual income throughout the year and report any changes to Healthcare.gov. Subsidies and cost reduction benefits may be repayable if one’s actual income as reported on their income tax return is greater than estimated.
Indemnity Health Insurance
Indemnity health insurance plans provide a fixed dollar benefit for the array of medical services it covers – ranging from doctor visits to hospital stays, chemotherapy and more. Indemnity plans pay the same benefits towards medical services through an in-network or out-of-network providers
The key objective of an indemnity plan is to empower people to be consumers of their healthcare services. If you know how much the insurance will cover, you would be more likely to get pricing for medical services beforehand to see how far your money will go. We help our clients find the best prices for labs, prescriptions, diagnostic services, and out-patient surgeries, allowing them to make informed choices when requiring these services to get the most value out of their coverage.
Who fits this plan?
People with minor or no pre-existing conditions of all ages. The structure of these plans provides layers of coverage for accidents, generally resulting in excess money paid to the policyholder after all the medical bills are paid.
This type of plan can be an affordable option for small businesses looking to offer health coverage to their staff. There is a lot of flexibility to customize plans for the workforce.
Medical Cost Sharing Plans
Medical cost sharing plans are a non-traditional approach to healthcare cost management. They are managed by a benevolent organization that pools the monthly membership fees of the members and shares in the medical costs of larger medical needs. Medical cost sharing plans are not regulated, so many people are concerned about there not being funds to pay medical bills. We partner with an organization that has a proven track record of covering their members’ medical costs and doesn’t require the member to pay the bills and get reimbursed. As long as the member fulfills their financial obligation towards the cost of medical expenses incurred for a larger medical need, and their monthly membership fees are paid up to date, the cost sharing plan will share in the medical costs.
Who fits this plan?
There are special plans created specifically for 1099 and small business owners who are challenged to find affordable coverage. These plans can be offered to small groups of 3 or more employees (W2 and 1099).
Because cost sharing plans limit sharing in the first year for pre-existing conditions, someone who has ongoing health issues or would require a medical service for a pre-existing condition would not be a good fit. Diabetes, high cholesterol and high blood pressure are not considered pre-existing conditions as long as the member and has not been hospitalized in the past 12 months and controls these conditions through lifestyle and medications.
This is a good fit for people who never go to the doctor and want affordable catastrophic coverage.
Working with a reputable health insurance agent is key to finding the plan that fits your needs and budgets. Ensure you know they educate you on the risks attached to the different plans being proposed so you can feel comfortable with your decision.
Let us help you find health coverage that fits your needs and budget. There is no charge for our services, and we aim to eliminate the confusion and stress of choosing health coverage for yourself, your family and/or your employees.
Visit our online calendar to set up a time for us to talk.