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We are presenting this information as a helpful guide for you to make an informed decision on which plan to buy and which benefits to include. This guide is presented in general terms and attempts to explain how health insurance plans work. Not all plans work equally nor does this imply that this information is valid in all states or situations. It does however, give the general workings of many health insurance plans and how deductibles, coinsurance, and copays function.

Health Insurance Premiums

It is no breaking news that health insurance premiums are at an all time high. There are many factors involved in this increase and many different opinions on what causes it. There are also many ways to lower your insurance premiums significantly. The insurance companies blame the doctors and the doctors blame the insurance companies, while others blame the legislature. We do not argue that all these are factors in the high cost of health insurance. However, the most obvious reason is that medical research, disease cure breakthrough, and the huge improvements in health maintenance are very expensive. With that being said, we will leave that subject alone for now.


How do you lower your health insurance premiums?

There are lots of ways to decrease your health insurance premiums. Health insurance plans today, have many bells and whistles or added benefits that you may or may not need. By decreasing some of these extras, you can often significantly reduce your premiums and still have a very good policy. Let's take the following example.

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Top 10 Things to Know about Health Insurance (from money.com)

1. Insurance costs a lot, but having none costs more.
There are sensible ways to save money on insurance, but skipping coverage isn't one of them. Medical bills from even a minor car accident can deplete your savings -- a major illness can push you into bankruptcy.

2. If your employer offers insurance, grab it.
Group coverage, particularly when it's employer-subsidized, is almost always a better deal than anything you can get on your own, even if you're young and healthy. If you're NOT young and healthy, it's definitely a better deal.

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MediCare and Your Healthcare Coverage

Here are resources to help you with MediCare decisions:

  The Official U.S. Government Site for People with Medicare



 

 

 

How do you lower your health insurance premiums?

There are lots of ways to decrease your health insurance premiums. Health insurance plans today, have many bells and whistles or added benefits that you may or may not need. By decreasing some of these extras, you can often significantly reduce your premiums and still have a very good policy. Let's take the following example.

COPAYS

A $20 doctor office copay is much more expensive than a $25 doctor office copay. A $30 copay is much less again, as is a $40 copay. Let's assume that the premium associated with a $20 copay is an additional $38 per month in premium. A $40 copay being an additional $12 per month. No copay at all would of course be $0.

You would then be paying an additional premium of $26 per month to protect yourself against a "potential loss" or exposure of $20 each time you used the doctor office copay. Please remember that these numbers are just made up for sake of example. The point of this explanation is to encourage you to "do the math", when selecting benefits.

DEDUCTIBLES

Now let's put the deductible under the glass and examine. The higher the deductible, the lower the premium. Make a judgment based on your own financial capabilities and not just on what "sounds" good on the surface. Ok, now for the example with assumed numbers.

Let us assume a $250 deductible is more expensive by $100 per month, than a $750 deductible. The deductible is probably the most effective way of managing your premiums as it impacts the premium more than just about any other optional factor. In this example you are paying an additional $1200 per year to protect yourself against a "potential loss" or exposure of $500 more out of your pocket. Once again, it pays to do the math. Many insured's find that raising the deductible saves them hundreds and even thousands of dollars yearly without exposing themselves to much more risk.

How much risk are you willing to take and at what price? At what level does the insurance policy cost more than what it is worth? At what level of premium does the insurance policy become a "bill paying service" instead of a "safety net" to protect you against significant financial loss.

CO-INSURANCE

Co-insurance levels should be looked at under the same magnification. A health insurance plan with an 80/20 or 80% co-insurance level is much higher in general than is a 50/50 or 50% plan. These co-insurance levels have cut offs or Maximum Out Of Pockets to protect you against a devastating loss. Once again, risk is really the subject at hand.
A health insurance plan (X) that has a $750 deductible and 80/20 to $5000 for example is $280 per month. A health insurance plan (Y) that has a $250 deductible and 80/20 to $5000 is $480 per month. Both plans have 100% coverage up to $5 million after the Maximum Out of Pocket has been met.

Your Maximum Out of Pocket for Plan (X) would be $1750 per year.

Your Maximum Out of Pocket for Plan (Y) would be $1250 per year.

Your increased "potential loss" or exposure would be $500 in any given year.

You would be paying $2400 per year to protect yourself against this "potential loss" or exposure of $500.

Please remember that these numbers are not completely accurate and are only being used for showing how certain options within a health insurance policy can impact the premium. Weigh out the risk and "potential loss" exposure along with the premiums associated with these options. In order to compare benefits and risk against premium cost, you should get a quote that offers several different option levels for each of the above and calculate the differences in premium. There are many differences in insurance policies as well as insurance companies. Once you get a quote, please feel free to call EGS Brokerage and get more detailed information on the policy you are interested in. Only a qualified insurance agent can really answer these questions for you and fully explain differences among policies. Never shop for health insurance on the basis of premium alone. We want you to make informed decisions and buy what is right for your individual situation.

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Top 10 Things to Know about Health Insurance (from money.com)

1. Insurance costs a lot, but having none costs more.
There are sensible ways to save money on insurance, but skipping coverage isn't one of them. Medical bills from even a minor car accident can deplete your savings -- a major illness can push you into bankruptcy.

2. If your employer offers insurance, grab it.
Group coverage, particularly when it's employer-subsidized, is almost always a better deal than anything you can get on your own, even if you're young and healthy. If you're NOT young and healthy, it's definitely a better deal.

3. Comparing plans is tough but necessary.
Unfortunately, there is no such thing as standard coverage. Benefits and costs vary widely from plan to plan. If you have choices, you'll have to examine each one closely to find the best deal.

4. The lowest premium isn't always the cheapest plan.
What your insurance covers is just as important as, and sometimes more important than, what you pay up front. Ultimately, the cheapest plan is the one with the best price for the benefits you're most likely to use.

5. Even good coverage can have big loopholes.
You can count on your health insurance to cover you for a hospital stay. Most policies cover doctor visits, but benefits for mental health, prescription drugs, and dental care are strictly optional.

6. You'll pay more for freedom.
Plans with the most comprehensive coverage at the lowest out-of-pocket cost require you to use a specified network of hospitals, doctors, labs, and other providers. The more flexibility you demand, the more you'll pay, in either premiums or co-payments.

7. You can check out networks before signing up.
A growing number of public and private sources compile information on the track records of individual doctors, hospitals, and health plans.

8. You can keep your insurance if you lose your job.
State and federal regulations protect you from losing your health coverage just because you lose your job. Unfortunately, they offer little protection from high premium costs.

9. Working couples have more to think about.
If you and your spouse both get health insurance at work, you must sort out whether it makes more sense to have two policies or for one of you to cover the other. If you have kids, you need to decide who's going to cover them.

10. Tax breaks can help.
Ordinarily, medical expenses, including insurance premiums, are not tax deductible until they exceed 7.5% of your income. However, if you're self-employed or your employer offers a flexible spending account, you can get a tax break without meeting the threshold.

 

 

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