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Health insurance
is very expensive these days so you don't want
to pay more than you have to when sickness or
injury occurs. It can be quite costly to use
your plan incorrectly or not to take full
advantage it. Here are a few quick tips to help
you get the most of you California health
insurance plan.
Understand the health plan you are buying.
We fully understand that
the options on the market can be overwhelming
and the actual language the plans are written in
can be very difficult to understand. People have
a tendency to make quick decisions and hope for
the best when confronted with this type of
situation. STOP. First, find a knowledgeable
California health
insurance broker
(hint hint...us at
Pacific Health Brokers)
and ask the questions that are most important to
you. It's good to research health insurance
online but even with the detailed articles on
our site, a good agent or broker can really help
the process. Half the time, the applicant will
go with a less expensive plan after speaking
with us, and half the time, more expensive. The
important part is that you have the right plan
and this will be different for each person.
Interestingly, there are two main camps of
incorrect plan choice that we run into.
1. Too little health
insurance coverage.
The carriers are increasingly rolling out plans
that carve out certain benefits or provide
hospital only coverage. Of course these tend to
be some of the least expensive plans on the
market. The problem is that you could wind up
with a $20,000 bill that's not covered. This
defeats the purpose of having insurance. There
is usually a comprehensive plan that's
comparable or slightly higher price-wise. We can
help you find it.
2.
Too much health insurance coverage.
It rarely makes
sense to go higher than the middle priced plans,
especially since you have to be healthy to
qualify for coverage anyway. When you look at
the premium difference over a year's time, it
usually makes sense to save the premium and take
the higher deductible. If you have a bad year,
it's probably a wash since you're saving on the
premium. With an average or good year, you keep
the premium difference in your pocket.
The final take
away is that you really want to know the kind of
plan you are buying. We have dozens of pages
that help you to analyze the plans and narrow
your options but ultimately a professional agent
on the other side of a phone is nearly
impossible to beat. Or...you can spend the hours
studying yourself.
Work within the
rules of your California health insurance plan
This can be quite
different between
PPO
and
HMO
plans so let's look at both.
HMOs.
HMO's by definition are
much more structured and you really need to stay
within the rules or you can have quite a bit
more out of pocket. The key point is always ask
first. Some plans let you self refer to
specialist but don't assume. Your Primary Care
physician is your point of contact for all care.
Run any moves by the office first. This can
include procedures you want done (MRI,
diagnostics, etc); seeing a specialist; and
emergency or out of area care. Your take away is
always Authorize before; Ask during; and Notify
after. Make sure to also take advantage of low
cost
preventive
check ups and labs. Ask your primary care about
Annual check ups, preventative treatments, and
other benefits.
PPOs.
The key point
with PPO's is to stay in network and price shop.
By definition a PPO plan is a big group
discount. The carrier tells the doctors that
contract with it on a PPO basis, "We're going to
bring a lot of patients your way, but in return,
discount your services when they come in". If
you go out of this network, you will pay more
out of pocket. Sometimes, much more. Another key
points that most people don't realize is that
you can and should shop health care services on
the market within the PPO network. For example,
I needed an MRI for an ACL repair and the doctor
recommended the local hospital (which happens to
be one of the most expensive in the State). I
asked if there was an alternative and the doctor
referred me to a competing imaging center. The
cost at the hospital would have been $2000 while
the imaging center was $800 for the exact same
service. As long as the doctor recommends the
alternative, check their PPO prices. Now that
deductibles and cost sharing are a main
component of PPO plans, enrollees need to change
their mindset. Healthcare is one of the few (if
not only) market where people do not think to
"shop". This will change significantly going
forward as the difference is money in your
pocket. The old plans with very rich plans are
gone primarily because they promoted a
disconnect between the consumer (you) and the
actual cost of health care.
Prescription
coverage and your California health insurance
plan
Brand name
medications
and their subsequent direct marketing to the
consumer have significantly altered the
healthcare landscape (and your monthly premium).
This will only continue as new and more targeted
medications hit the market. They are expensive
but also very effective so it's a mixed
blessing. Work with your doctor to see if there
is a generic that will work instead of a brand
name medication. You will pay much less out of
pocket this way with either HMO or PPO's. If
your doctor is fine with the alternative, give
it a try.
With these general tips,
you should be able to get the most out of your
California health
insurance plan.
Find more information on each topic below:
Other important concepts to
help you understand your
California health insurance
quote are:
Health
Insurance Plans and Prescriptions
PPO
versus HMO plans
The concept of health
insurance
A quick introduction to
California health insurance history
To run
your instant health insurance:
California Individual Family health insurance
quote
California group health insurance quote
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