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Health insurance protects you and your family from the high costs of preventative care, as well as emergency and treatment services. For people who don’t have insurance through an employer, evaluating your options can be daunting. This guide presents the choices and opportunities available in the Florida health insurance market to help make this process easier.
Some things in life we have no control over. But some things we can control.
Having adequate health insurance can buy you peace of mind.
It isn’t surprising that cost is the primary factor determining what kind of health insurance people opt for. Luckily, there are a wide range of options available to help you find a plan that meets your budget. Most people seeking health insurance do so because:
If you fall into one of these categories and do not have insurance, you may have to pay a penalty that is more expensive than the cost of a policy. Rather than go without protection, explore your options, and you may find the perfect plan to fit your needs.
The Affordable Care Act, also referred to as Obama Care, requires that everyone have insurance coverage or pay a penalty, although there are a few exceptions. This law states that no one can be denied coverage or charged excessive premiums due to a pre-existing condition, and also established 10 essential services that all policies must include for a person to qualify as insured.
In addition to establishing these requirements, the government created a marketplace for people to purchase appropriate coverage. There are specific timeframes during which you can apply for coverage as well as special enrollment periods that address significant life changes, such as loss of a job or the birth or adoption of a child. Some people who enroll in an insurance program through the marketplace qualify for a federal subsidy and this opportunity is only available through a government exchange.
The plans offered through the marketplace are organized by metals which are bronze, silver, gold, and platinum. There is also a catastrophic category that is only available for people under the age of 30. The costs of these plans increase according to the metals, with bronze being the least expensive and platinum the highest. The different costs, copays, and service options for each of these levels, and you need to evaluate which is best for your needs.
Although the marketplace can be a good place to begin your health insurance search, you shouldn’t stop there. There are five great reasons to look for coverage outside of the government exchange:
The plans offered through the marketplace must have the same price, but outside of the exchange, you have a wider range of prices and choices. While these plans must include the 10 essential benefits, you can also add benefits that better meet the needs of you and your family.
Not every provider participates in the marketplace, so you have a wider selection of if you go outside it. For example, your preferred physician, hospital or clinic might not be covered in the plans offered through the exchange, but you can purchase an outside plan that includes these providers. This can be especially important if you or a loved one has a chronic condition that requires a specialist. With the right plan, you won’t have to change doctors.
You have two costs associated with your insurance premium and deductible. The premium is the monthly amount you pay to have insurance. The deductible is the out of pocket cost you pay for services you use. Policies available outside of the marketplace offer greater choices on deductibles than those within it.
Many people find that they have more options for drug coverage off-exchange than on. Plans can limit what drugs are covered or reimburse more for generic drugs than name-brand, so you should check that any drugs you take are specifically included in your plan.
Plans such as long-term care insurance and short-term medical insurance are not available through the marketplace. In addition, many insurance companies do not participate in some or all of the exchanges. To get the full range of options available, you need to look outside of the marketplace.
Not everyone fits into the metal levels, and going outside of the exchange gives people the ability to get the coverage they need for the price they can afford. In these instances, you would purchase your policy directly from a company or through an insurance agent.
Before you begin your search for health insurance you should identify all of the benefits you and your family need to maintain health and address anticipated issues. You should also consider your budget, preferred providers, and any medications being taken. In addition, you need to compare:
There are four basic types of health insurance plans, and you need to understand the benefits and drawbacks of each one before you make a decision. Begin by evaluating how you and your family currently use healthcare services. Identify the type and amount of treatment you have received in the past to help you anticipate future usage.
In a Health Maintenance Organization (HMO) or a Point of Service Plan (POS), your primary physician makes the referrals to specialists, which can save you time but limits your choices. If you or a family member has a chronic condition that requires specialized care, you may want to choose a Preferred Provider Organization (PPO) or an Exclusive Provider Organization (EPO) so you can continue to see your existing specialist or have a choice in who you use. A PPO and POS are good options if you live in a rural area with limited access to doctors because you will pay less for out of network services than with the other plans.
| Plan Type | Do you have to stay in network to get coverage? | Do procedures & specialists require a referral? | Best if You Want: |
|---|---|---|---|
| HMO: Health Maintenance Organization | Yes, except for emergencies. | Yes | Lower out-of-pocket costs and a primary doctor that coordinates your care for you, including ordering tests and working with your specialists. |
| PPO: Preferred Provider Organization | No, but in-network care is less expensive. | No | More provider options and no required referrals. |
| EPO: Exclusive Provider Organization | Yes, except for emergencies. | No | Lower out-of-pocket costs but no required referrals. |
| POS: Point of Service Plan | No, but in-network care is less expensive; you need a referral to go out of network. | Yes | More provider options and a primary doctor that coordinates your care for you, including ordering tests and working with your specialists. |
Your costs will be lower if you receive care from a physician or other provider within the plan network because the insurance company has contracted for specific rates with these providers. For this reason, check that the physicians you and your family prefer are in the networks you are considering. When in doubt, ask your doctor’s billing manager if they participate in the network. If you don’t have a preferred physician, choose a plan with a large network so you will have more options for care and can avoid out of network costs.
These costs are the ones you pay in addition to the premiums.
a. A copay is a predetermined amount you pay for services at the time of care. It is often a set amount, such as $25 each time you see your doctor. The amount of the copay often depends on the type of service you receive.
b. A deductible is how much you annually pay out of pocket before your health insurance pays a larger portion of your bills. This can be per individual and/or per family and can have a significant impact on your total out of pocket expenses. The difference between per individual and per family deductibles can be significant so carefully check your policy options on this issue.
c. The coinsurance is the percentage of medical costs you pay after the deductible has been met. It can be as little as 5% or as much as 30%. If you anticipate meeting your deductible, this amount is important.
Under the Affordable Care Act, there are set out of pocket maximums that limit your total financial exposure. If you purchase out of market insurance, these maximums do not apply but others are likely to be in place.
The challenge with out of pocket expenses is doing a direct comparison between plans. Each plan may define service categories differently, so you might think that the copay is the same between plans, but in fact, they are different. You must carefully read the plans, paying close attention to the services you might need, to truly be able to compare the policies.
It is also important to note that the higher your copays and deductibles, the lower your premiums. Just remember, what you save in monthly payments could cost you much more in out of pocket expenses.
Some policies exclude coverage for outpatient treatment for specific types of care or inpatient treatment for others. Many policies limit the drugs that are covered or tests or treatments that they will allow. When comparing plans, make sure that the services and medications you need are included in the coverage.
Many policies limit the amount of care they will pay for when you are out of state. If you travel frequently, check the terms of your coverage to learn what is and is not included if you are injured or ill in another state. You may wish to purchase a PPO or POS plan that does pay for some out of network care. If you plan to travel outside of the country, first check your policy to see what they cover, and purchase travel health insurance if you want additional protection.
Comparing insurance plans is a time consuming but necessary process that will save you money and avoid unpleasant surprises later. Be sure you know which providers, services, and medications are most important to you, and select a plan that offers the most coverage for a low cost.
At Alliance, we represent the major healthcare insurers in Florida, including Florida Blue, Travelers, Anchor, Progressive, Tower Hill Insurance and more. We can save you time and help you avoid frustration by identifying the best policies that meet the unique needs of you and your family and providing the information necessary for a side-by-side comparison. Contact us today for a free quote or to find competitive policies. You can also call us at (866) 771-4715 to speak with one of our knowledgeable agents. We know health insurance, so let us help you make the right decision.
It is very important to get the health insurance Florida that will meet your healthcare needs. The past few years saw the rise of health insurance cost and because of this, more and more people are now uninsured. Thankfully, the state government, as well as a number of nonprofit organizations, have taken the effort to cut the cost of health insurance. In this way, those who are in dire need of medical care will have easy access to health insurance.
Health insurance Florida is available either for individuals or for groups. It offers not only protection but also easy access to quality health care services. Likewise, health insurance covers health care for children up to age 19, pregnant women, self-employed individuals, and families. Remember that one company’s rate for health insurance significantly differs from another insurance company. So to save time and money, it is best to compare what insurance companies have to offer and then choose the best option that will suit your needs.
There is a wide array of health insurance plans that you can choose from, many of which provide a variety of benefits, covering the cost of medication, prescriptions, doctor visits, and hospitalization. Among the types of health insurance Florida that you can choose from are individual health insurance, small group health insurance that includes health savings account (HSA) and health reimbursement.
Getting qualified for a medical insurance Florida plan requires passing through a medical examination. Upon qualifying for a health insurance plan, the next step is paying for the premium. Your premium will depend on your age and medical history. The cheapest that you can choose is individual health insurance, which is much more affordable when compared to group health insurance.
You will really have to spend some time to look for an affordable yet quality health insurance. Ask the help of an insurance agent or broker and you may also check many health insurance websites based in Florida to make sure that you are choosing the best health insurance plan.
These days, the increasing cost for health care is propelling more and more people to look for health insurance and as per today’s economy, the insurance should be affordable. If you are living in Florida and looking for health insurance, then you may come across a highly competitive market. The completion among insurance services offering health insurance Florida can benefit you in many ways. At the same time, it can even make the right call for certain bad things for the customers who are looking for affordable insurance policies.
Get a cheap deal on health insurance Florida:
However, the good thing is that due to the competition, these service providers are now lowering their rates to stay tuned in this business. These insurance companies are continually offering affordable health insurance. So, you are always having a chance to get the health insurance in this part of the world in cheap. Despite all these facts, finding an affordable health insurance Florida can be tough on most of the occasions. To get this sort of insurance policy, you must first find out the best and highest-quality insurance agent. Following a few steps can really make the way easier for you while looking for an affordable health insurance Florida.
There are as well a few basic things that you may watch out for protecting yourself. Even though the high deductible policies will mean the lower insurance premiums than the co pay plans, deductibles aren’t all structured same. You can lose some money just by comparing the plans, which have same deductible amount however apply deductible differently. It is just like comparing oranges to apples. You will just find the lowest cost while you compare the policies, which give the similar amount of the coverage.
Here is one example. In case, you get the high deductible policy for the family of 4, you have to check if annual deductible is of per person and not. In case, you get $5,000 of deductible plan, for example, does this mean all 4 of you need to spend around $5,000 in one year before the coverage starts? There’s the big difference in having to spend around $20,000 and $5,000 to meet annual deductible. The exclusions on the coverage can as well set you back with the unexpected out of the pocket expenses. There are the health insurance policies for Florida, which excludes some health care, like the outpatient treatment or else prescriptions. The prescriptions are among the biggest yearly health care costs, thus check which of the medications are been covered by the plan in order to avoid the huge out of the pocket costs. Florida health insurance policy is as well open to the “federally eligible individuals” like defined by Health Insurance Portability & Accountability Act 1996. Act protects the health insurance coverage for your family and you while you change and lose the job. Florida health insurance plans are made to give complete relief to the families who don’t qualify for the highly rated insurance programs nor to have an ability to pay expensive installments of the private insurance.
Tips That Will Help You Choose The Health Insurance You Need
Health insurance is a necessity. Anything can happen to anyone at anytime. You could be doing a simple rearrangement of furniture and end up with a hernia in one breath. Sometimes, finding the right policy is difficult, but this article will offer some advice on how to sift through all of the options.
When traveling out of the state or out of the country, check with your health insurance company first to make sure you are covered for illness or injury. Especially if you rely on Medicare for health insurance, you may not have to travel far to be outside your insurance company’s network.
When purchasing health insurance, try to affiliate with a group. A group will offer you better prices than an individual policy. Even if you’re not employed with a company that offers group insurance, you might be able to affiliate with a trade organization or alumni association. This could allow you to pay group premiums and save serious money.
If you’re self-employed, remember that health insurance is tax-deductible. Talking to your accountant could mean that your health insurance costs less out of pocket than you expected, because of tax law allowances on your adjusted gross income. Medical costs can also be tax deductible however, so talk to a tax expert to decide what will offer you the most savings.
Take advantage of any wellness programs offered by both your workplace and your health insurance company. Both of these may reward you in different ways, such as your workplace offering a cash-incentive for completing an exercise program, or your insurance company lowering your premiums if you follow a quit-smoking one. These offers are rare, but helpful.
Thoroughly read your entire health insurance contract, and ask for clarifications and explanations for things you do not quite understand. Your insurance agent should be ready and willing to explain every bit of your contract to you, should the need arise. If he or she give you an answer that you don’t like, you may want to find a different policy.
Getting health insurance after the fact is not really a great way to handle sickness or injury, but in some states in the country, you can actually get an insurance policy after you’ve fallen ill to help take the edge off of the bills. This is one of the new mandates with America’s new healthcare legislation, and it can definitely help you out.
To be insured is to have a peace of mind, knowing that if something happens not only will you be able to get treatment, but you will be able to do so without breaking your wallet. This article offered some advice on health insurance so that you too could have that peace of mind.
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