Health Insurance Checklist for the New Year

Have you compared rates in the past Year?
New plans are introduced all the time and if you’re healthy you may be able to reduce your monthly premiums. If you consider a higher deductible plan, be sure you can afford the deductible in case of an accident or illness.

Are you paying for benefits you don’t need?
Guys, you don’t need maternity coverage! Ladies, you don’t either if you are past your child bearing years! If you’re paying for benefits you don’t use (like maternity or chiropractic care), you might save money with a plan that excludes those benefits. On the other hand, if you’re paying too much out of pocket for recurring medical services (like prescriptions or checkups), consider a plan that adds these benefits.

Can you save by mixing and matching health plans?
If your whole family is covered under a single plan, you could be missing out on savings. When some family members are healthier than others, or see doctors less frequently, or don’t need certain benefits like Prescriptions or Maternity, you might save by tailoring the coverage to your individual needs.

Have you experienced any big life changes?
If you recently had a child, shift in income or change in marital status – or if you anticipate these events in the year to come — it may be time to change your health insurance coverage.

Have you talked to your broker or accountant about tax advantaged H.S.A. Plans?If you are self employed, or otherwise have an individual policy, there are many great reasons to consider an H.S.A. if you are relatively healthy and don’t need prescription drug coverage.

Pregnant and without Health Insurance?

Naturally, the ideal time to plan for maternity expenses is before you become pregnant. The whole concept of health insurance is to plan ahead, to have medical coverage for potential future events. Not that it is impossible to obtain health insurance for maternity expenses after you become pregnant, but it is much more difficult to get maternity health coverage once baby is on the way. Health insurance companies look at pregnancy as a "pre-existing condition." If a woman applies for health insurance that covers maternity after she becomes pregnant she will be using healthcare dollars, without having paid her share of premiums to cover the expense. That of course defeats the reason insurance works.

So, what do you do? There are several ways to obtain affordable health issuance coverage for delivery and maternity expenses:

First, check to see if you can obtain health insurance through your employer. Keep in mind that if you are working, not all companies provide health insurance, and even if they do, not all employee based group health insurance covers maternity expenses. The first step is to check with your benefits advisor at work if applicable, and see what your health insurance covers. If your plan doesn’t cover maternity or you don’t work for an employer with health insurance available, see what may be offered under your spouse's health insurance plan if available. Even if the specific pregnancy is not covered under your plan, illness or other complications resulting from the pregnancy or childbirth will normally be covered under your regular health insurance.

Second, if you are low income you may qualify for the Pregnancy Related Medical program in Washington State through Medicaid. This is a great program that covers the mother’s prenatal care, labor and delivery expenses, as well as the new baby’s expenses for a period after the birth. There is currently no waiting list for Pregnancy Related Medical as there is for the Washington State Basic Health program.

Finally, if insurance through your employer or your spouse is not an option and you do not qualify for Pregnancy Related Medical through Medicaid, your remaining option is to purchase a private health insurance policy through My Health Insurance of Washington. Of course, if you are buying a policy after you are already pregnant, that pregnancy may still not be covered (there are many ways to get around the preexisting condition however) but at least complications resulting from your pregnancy may be. Since average delivery expenses for a routine birth are around $10,000 (without complications!) it does make sense to pay for individual health insurance, even if the premiums may be several hundred dollars a month. While shopping for a private health insurance policy, keep in mind that most low-cost health insurance plans do not include maternity coverage so be very careful about what you buy. Sometimes buying a “cheap” policy to save a few dollars each month will cost you thousands if the pregnancy is not covered.

How do you figure all this out? Call me, I'd love to help!

www.myhealthinsurancewa.com 1-877-877-9545

Finding Health Insurance for Individuals and the Self Employed

Finding Health Insurance if you are an Individual or Self Employed in Washington State can be a daunting and confusing task. Luckily there are many options to choose from but this itself can be a problem; how do you know which plan is right for you? Do you pick a plan with the lowest monthly premium, or the lowest copay?

Everyone’s needs are different, and thus the best plan for a friend or coworker is likely not the right plan for you. Pick the wrong plan and you could pay a high financial price beyond just the monthly premiums. Here are some basics to think about when starting to search for the right plan. Naturally, before making a final determination, you will want to get expert advice from someone like My Health Insurance of Washington who will help guide you to the right plan to fit your needs.

Catastrophic vs. Comprehensive Plans: Health Insurance plans fall into one of these two categories. While both may offer a maximum “cap” on the amount you would pay per year if you had a major medical event, there are important differences.

Catastrophic plans have higher deductibles (you pay more up front for medical care) and more limited coverage. They may limit the number of times you can visit a doctor and generally exclude maternity coverage and prescription medications. Generally if you purchase a Catastrophic policy it will cost less in monthly premium but you will usually end up paying more out of your pocket for medical expenses when you are sick or hospitalized.

Comprehensive plans have lower deductibles and a more complete benefit package that often includes maternity coverage and prescription medications, along with unlimited visits to the doctor. Naturally, these plans cost more on a monthly basis than Catastrophic plans, but if you get sick or need medications, you will pay less out of your own pocket.

For fairly healthy and younger people, Catastrophic plans can offer good value. However, if you have known health conditions, take medications, or expect something to crop up in the near future, it may be better to pay more per month with a Comprehensive plan. Thus, paying more for a Comprehensive plan may actually save you money in the long run!

PPO Plans vs. HMO Plans: These are the two most common types of plans in Washington. Preferred Provider plans (PPO Plans) and Health Maintenance Organization (HMO) plans. An example of a PPO plan is Regence Blue Shield, while Group Health offers HMO plans (Group Health also offer plans that act like a combination of a PPO and HMO as well).

PPO Plans provide the maximum benefit if you stay within the plan's provider network. The physicians, hospitals and other medical providers have agreed to the plan's schedule of payments for services performed. This network is usually quite large and provides many choices of doctors and other medical providers to choose from. These plans usually do allow you to receive healthcare services outside their network of providers, but at an additional cost to you. Some may require the selection of a Primary Care Physician (PCP), a personal physician who directs all your care and who's written referral you need prior to visiting a specialist. Naturally, with a large network of doctors, you can expect to pay more for a PPO type plan.

HMO Plans require you to use HMO doctors and their own facilities to obtain benefits. This type of plan provides relatively fewer doctors and other medical providers from which to choose. With this type of plan you may not have any coverage outside the HMO network so this is a consideration. If you are not that picky about seeing a particular doctor however, an HMO may be a good option that can save you money. HMO’s are not for everyone, as you need to stay within their network or face high extra costs when you see a non-network doctor, but can save you money over the long run.

Which Health Insurance Company should you choose? There are several good insurance company options available to Individuals and Self Employed people in Washington. These include Lifewise, Regence, Assurant, Asuris, KPS, and Group Health. Make sure you pick a reputable carrier with good customer service and which pays their claims, and not a carrier based somewhere far away like the Mid-West or Tennessee.

All these carriers offer various plans at different price points. While their coverage for many plans may be quite similar, the monthly cost may be much higher at one carrier vs. another, so it pays to shop around. Why pay more for a plan at one carrier, when the similar coverage plan at another costs less per month? Since rates and benefits change from year to year, it is always best to have someone like My Health Insurance of Washington shop your plan each year to make sure you are getting the best bang for your buck.

My Health Insurance of Washington specializes in helping individuals, families, the self-employed, and small business find quality health insurance plans to meet their health and financial needs. Based in Washington State, their sole focus in on Washington State Health Insurance. www.myhealthinsurancewa.com 1-877-877-9545