What is Health Insurance?
Health insurance helps you pay for medical services and sometimes prescription drugs. Once you purchase insurance coverage, you and your health insurer each agree to pay a part of your medical expenses–usually a certain dollar amount or percentage of the expenses.
How do I obtain Health Coverage?
You can get health care coverage through:
- A plan purchased from First Family Insurance
- A group coverage plan at your job or your spouse or partner’s job
- Your parents’ insurance plan, if you are under 26 years old
- Government programs such as Medicare, Medicaid, or Children’s Health Insurance Program (CHIP)
- The Veterans Administration or TRICARE for military personnel
- Your state, if it provides a health insurance plan
- Continuing employer coverage from your former employer, on a temporary basis under the Consolidated Omnibus Budget Reconciliation Act (COBRA)
What types of Health Insurance plans are available?
When purchasing health insurance, your choices typically fall into one of three categories:
- Traditional fee-for-service health insurance plans are usually the most expensive choice, but they offer you the most flexibility in choosing health care providers.
- Health maintenance organizations (HMOs) offer lower co-payments and cover the costs of more preventive care, but your choice of health care providers is limited to those who are part of the plan.
- Preferred provider organizations (PPOs) offer lower co-payments like HMOs but give you more flexibility in selecting a provider.
Choosing a Health Insurance Plan
Speak to one of our licensed health insurance agents and ask questions, such as:
- Do I have the right to go to any doctor, hospital, clinic, or pharmacy I choose?
- Are specialists, such as eye doctors and dentists, covered?
- Does the plan cover special conditions or treatments such as pregnancy, psychiatric care, and physical therapy?
- Does the plan cover home care or nursing home care?
- Will the plan cover medications my physician may prescribe?
- Deductibles are the amount you must pay before your insurance company will pay a claim. These differ from co-payments, which are the amount of money you pay when you receive medical services or a prescription.
- What is the most I will have to pay out of my own pocket to cover expenses?
- If there is a dispute about a bill or service, how is it handled?
The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families the right to choose to continue group health coverage provided by their group health plan for limited periods of time.
There are three basic requirements that must be met for you to be entitled to elect COBRA continuation coverage:
- Your group health plan must be covered by COBRA
- A qualifying event must occur (for example, voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, or divorce)
- You must be a qualified beneficiary for that event
If you are entitled to elect COBRA continuation coverage, you must be given an election period of at least 60 days to choose whether or not to elect continuation coverage.
Under COBRA, group health plans must provide covered employees and their families with a notice explaining their COBRA rights. Plans must also have rules for how COBRA continuation coverage is offered, how qualified beneficiaries may elect continuation coverage, and when it can be terminated. COBRA is usually more expensive and the consumer could take on additional fees associated with this type of coverage.
What is Long-Term Care (LTC)?
Long-term care (LTC) is a variety of services that include medical and non-medical care for people who have chronic illnesses or disabilities.
Most health insurance plans and Medicare severely limit or exclude long-term care. If you want coverage, you may need a separate long-term care insurance policy. You should consider the cost of long-term care insurance as you plan for retirement.
These questions can help you evaluate long-term care insurance policies.
- What qualifies you for benefits? Some insurers say you must be unable to perform a specific number of the following activities of daily living: eating, walking, getting from bed to a chair, dressing, bathing, using a toilet, and remaining continent.
- What type of care is covered? Does the policy cover nursing home care? What about coverage for assisted living facilities that provide less client care than a nursing home? If you want to stay in your home, will it pay for care provided by visiting nurses and therapists? What about help with food preparation and housecleaning?
- What will the benefits amount be? Most plans are written to provide a specific dollar benefit per day. The benefit for home care is usually about half the nursing-home benefit. But some policies pay the same for both forms of care. Other plans pay only for your actual expenses.
- What is the benefits period? It is possible to get a policy with lifetime benefits but this can be very expensive. Other options for coverage are from one to six years. The average nursing home stay is about 2.5 years.
- Is the benefit adjusted for inflation? If you buy a policy prior to age 60, you face the risk that a fixed daily benefit will not be enough by the time you need it.
- Is there a waiting period before benefits begin? A 20 to 100 day period is not unusual.
What is the Health Insurance Marketplace?
A service that helps people shop for and enroll in affordable health insurance. The federal government operates the Marketplace, available at HealthCare.gov, for most states. Some states run their own Marketplaces.
When can you enroll in Marketplace plans?
Plans sold during Open Enrollment start January 1, 2018. After December 15, you can enroll in 2018 health insurance only if you qualify for a Special Enrollment Period. Contact one of our agents at anytime to see when you can enroll.
By providing your contact information you are agreeing to be contacted by a licensed agent or sales representative by mail, phone, text or email to discuss Health Insurance Plans, Dental Insurance Plans, Association Plans, Medicare Advantage, Prescription drug Plans, Medicare Supplement Insurance Plans, Property & Casualty Insurance and any other products or services we may offer even if you are on the National Do Not Call Registry. You also agree that we may contact you via a pre-recorded message to verify your interest. Neither First Family Insurance nor its agents are connected with either the Federal Medicare Program or Healthcare.gov.