Ever feel confused by your health care plan?
What’s a copay? A deductible? An out of pocket maximum? How does my plan work if I have to go to the Dr.?
Here are some simple ways to understand how it works and get some peace of mind!
Preventive care: Yearly checkups, preventive tests and other things that keep you healthy!
Copay (Copayment): When you see a Dr., most plans have you pay a certain amount to the Dr. for the visit; it is a fixed dollar amount paid to your Dr. This amount generally does not go toward your deductible or out of pocket maximum.
Deductible: You pay this amount for covered services each calendar benefit year before the plan pays their portion. Covered services that would apply to the deductible may include labs, x-rays, surgeon and hospital fees.
Coinsurance: Once you’ve met your deductible, the carrier will start paying a portion of claims. The health care bills that remain are shared between you and the carrier, this is called coinsurance. The carrier generally pays between 50% and 100% of the bill.
Out of pocket maximum: Every plan has an out of pocket maximum. The amount you pay in deductible and coinsurance are typically what make up your out of pocket maximum. Once you meet your out of pocket maximum the plan pays 100% of covered services for the rest of the calendar year. With some plans, however, Dr. visits and prescriptions are required even after the out of pocket maximum is met, be sure to check your specific plan requirements.
QUESTIONS??? Give me a call and I am happy to explain further! In general, the lower your deductible, copay and/or coinsurance, the more your premium. Keep this in mind when you’re thinking about the right plan for you!
Kim Brewer, Steven J. Erickson Insurance (619) 337-9980
A common question when getting yourself and your family covered is do I have to buy health insurance?
If you don’t have health insurance, you should. Health insurance is an important way to make sure we have access to medical care when we need it. Starting in January 2014, most people will be required to have health insurance or pay a penalty if they don’t. Coverage can include employer-provided insurance, coverage you buy on your own, Medicare or Medi-Cal.
The penalty phases in over three years and becomes increasingly severe. In 2014, the penalty will be 1 percent of annual income or $95, whichever is greater. By 2016, the penalty will be 2.5% of income or $695. This means that if you do not have coverage in 2014, you will be required to pay a penalty when you file your taxes at the end of the year.
The open enrollment period is expected to start this fall and continue until March 31, 2014. You must purchase health insurance during the open enrollment period to obtain coverage in 2014. If you have a life changing event such as the loss of a job, death of a spouse or birth of a child, you would be eligible for a special enrollment within 60 days of the event. If you do not enroll in the open enrollment period you will not be eligible to purchase individual health insurance until the next open enrollment period begins in October 2014.
We can help you navigate this system and be sure that you and your family are covered! Stay tuned for more details. In the meantime, if you have specific questions please give me a call!
Don’t leave yourself in the dark! Here are some answers to common questions about health care reform:
Q: What is health care reform?
A: “Health Care Reform” is a term that refers to the Affordable Care Act, which is the federal law passed in March 2010, as well as any state laws passed to put it in place. The intention of these laws are to help more people get healthcare that is affordable and to improve the quality of care.
Q: What do I need to do now?
A: You don’t really need to do anything right now, but you may need to take action around fall of this year 2013. The Health Insurance Marketplaces will open in October, so until then, you may want to learn all that you can about health care reform and how it will effect your health coverage.
Q: Need coverage now?
A: Why wait for a health care reform to take effect in 2014? Contact our Life and Health Specialist, Kim Brewer to help you find a plan that fits your needs now!
Still have more questions? Get all of your questions answered, by contacting us at the office. We are here to help you!
Ask for Kim Brewer at: 619-337-9980