FAQs

A: Well, there a few things to look at. Let's start with the premium: how much are you paying a month? 

Next, take a look at your deductible: this is what you pay before the insurance will even cover their part of the costs

Then, you have your copay: you know that cost you pay when you are at the reception desk at check-in? Yes, that's it. Or the amount you pay to get your prescriptions? Yep, you guessed it. That's the co-pay. This is in addition to your premium.

Next up is coinsurance: this is what you and the insurance cover once your deductible has been met. So if you ever hear 80/20, 70/30, 60/40, 50/50, this means the insurance will cover 80% of cost after deductible has been met, and you would owe 20% and so on and so forth with the above examples. So, which one does your current plan have?

Then you have your maximum out of pocket: This is what you will have to spend on services etc. in a year before the insurance will cover at 100%. For example, if your MOOP is at $10,000, your deductible, copays, & coinsurance payments will all go towards it. Once that is met, then the plan will cover expenses at 100%. Sometimes, we never reach that max. oop or if we do, it's towards the end of our policy year. Then, it'll start over with new policy year. Vicious cycle, eh? Yea, I know.

And lastly, you want to look at your network: HMO-Health Maintenance Organization, EPO-Exclusive Provider Organization, POS- it's not what you're thinking...or was it just me? 😂 Point of Service, PPO- Preferred Provider Organization. I'll explain these more in the next question.

A. Okay, let's get it!

HMO-Health Maintenance Organization: usually limits coverage to care from doctors who work for or contract with the HMO. You can forget about getting services covered that's out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. LIMITED

EPO-Exclusive Provider Organization: this is a managed care plan. Your services are covered only if you go to doctors, specialists, or hospitals in the plan's network (of course, except in an emergency). LIMITED

POS- Point of Service- are you going to admit, you thought it meant something else? :  this is the type of plan in which you pay less if you use doctors, hospitals, and other health care providers that belong to the plan's network. That means you can see out of network drs and facilities. You'd just me paying a bit more. Premiums are usually much higher. POS plans also require you to get a referral from your primary care doctor in order to see a specialist. Better, but still LIMITED

PPO- Preferred Provider Organization: this type of health plan contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan's network. You'd pay little more if out of network, but won't pay the entire cost of that service. Still a winner compared to others, in my opinion. BEST Why is it the best you ask? Because you have NATIONWIDE COVERAGE. 

A: If you go out of town, your PPO plan will go with you. If you go out of town and have a HMO, EPO, POS, well you're out of luck.  Those three networks are generally tied to your county and zipcode. If you go past your area and it's not an emergency, you're basically footing the entire cost of that service.

A: Just take a wild guess 😊. We offer PPO plans. Granted, all PPO plans are not created equal. The others from question 1 definitely factors in which plan is best for you.

A: You can call me your new best friend!! I'll definitely help you in any way I can. I want to educate, educate, educate. I am here for you.

A: Of course!! I wouldn't dare say you need to change plans if what you're already on is better or close to what we offer. I'm not in this for that. I genuinely care. Remember that!

A: Don't you know me by now?? 😊 Yes, for sure. Just reach out or complete the pre-call questionnaire and I will set a time for a quick chat with you. I have absolutely no problem doing that.