NOTE: Although the above will give you information on plans and companies available on the Marketplace, you are ENCOURAGED to call me to make sure you are getting your maximum subsidies and you avoid having to repay anything next year! Remember, it costs zero to use an agent!
Here is an example from March 2020 for a family of 4 (Primary and spouce are both in their low 40's and two kids are young teen-agers)
Blue Cross Philadelphia American Difference
Premium $1,703.86 $686.29 Savings-$1,017.57/mo $12,210.84/yr
Deductible $6,650 $4,500 New plan is ONLY for hospitalization!
Network Blue HMO PHCS PPO Nationwide coverage for PA
Max per year Unlimited $250,000 Can go up to $1,000,000 for $131 more PM
PCP $35 $0 Allows $160/visit X 20 max visits
Specialist $75 $0 Allows $200/visit included in the above
X-rays $40 AFTER DED $0 Allows $240 per visit
Labs $25 $0 Allows $120/visit
Generics $35 $0 Allows $30
Brand 40% AFTER DED $0 Allows $60
ER 40% AFTER DED $0 Allows $800
Critical Illness No Yes $15,000 on Prim & Spouse & $10k for kids
Accident No Yes Covers family
Disability No Yes Max $2k for 24 months
Acc Death No Yes $100,000
Now, here is the BEST part! The new plan INCLUDES $15,000 in critical illness for the Primary & Spouse and $10,000 on the dependants. It also includes Accident insurance, accidental death of $100,000 and DISABILITY income coverage on the Primary for up to 24 months for up to $2,000/month (or 60% of salary, whichever is lessor).
Why do I need Medical Insurance?
As medical care advances and treatments increase, health care costs also increase. The purpose of health insurance is to help you pay for care. It protects you and your family financially in the event of an unexpected serious illness or injury that could be very expensive. In addition, you are more likely to get routine and preventive care if you have health insurance.
You need health insurance because you cannot predict what your medical bills will be. In some years, your costs may be low. In other years, you may have very high medical expenses. If you have health insurance, you will have peace of mind in knowing that you are protected from most of these costs. You should not wait until you or a family member becomes seriously ill to try to purchase health insurance.
We also know that there is a link between having health insurance and getting better health care. Research shows that people with health insurance are more likely to have a regular doctor and to get care when they need it.
Most people get health insurance through their employers or organizations to which they belong. This is called group insurance. Some people do not have access to group insurance. They may choose to purchase their own individual health insurance directly from an insurance agency like james insurance consultants.
Many Americans get health insurance through government programs that operate at the national, State, and local levels. Examples include Medicare, Medicaid, and programs run by the Department of Veterans Affairs and Department of Defense.
If you are self-employed or your employer does not offer health insurance, you may not have access to group insurance. You may, however, be able to purchase individual coverage directly from an insurance company with the help of a licensed agent. When you buy your own health insurance, you will be responsible for paying the entire premium rather than sharing the cost with an employer. You should shop around to find a plan that fits your needs at a price that you are willing to pay, or, better still; use the services of a licensed independent agent to do your shopping for free!
Most self-employed workers are able to deduct their health insurance premiums from their Federal taxable income, providing them with an important tax saving. Most States also offer similar tax preferences. If you are self-employed and buy individual health insurance, you should consult a tax advisor to find out if you are eligible for this deduction.
Insurance plans differ greatly from one company to another and, within an insurance company, from one plan or product to another. Some plans have multiple products (options) from which you can choose; read carefully through the "fine print" to be sure you understand the various choices.
Which type is right for you?
Whether you are eligible for group insurance or choosing an individual plan, you should carefully compare costs and coverage. Be sure to compare:
Even if you do not get to choose your health plan—for example, if your employer offers only one plan-you still need to understand your coverage. What kinds of services are covered by the plan? What steps do you need to take to get the are you and your family members need? When do you need prior approval to ensure coverage for care (for example, elective hospitalization for scheduled surgery)? How are benefits paid; do you have to submit a claim?
Make sure you understand how your plan works. Don't wait until you need emergency care to ask questions.
If you are choosing between indemnity and managed care plans, remember that they may differ in several important ways, including:
Despite these differences, indemnity and managed care plans share some features. For example, both types of plans cover a wide array of medical, surgical, and hospital services. Most plans offer some coverage for prescription drugs. Some plans also have at least partial coverage for dentists and other providers.
The major difference between indemnity (non-network based coverage) and managed care plans (network-based coverage) concerns choice of doctors, hospitals, and other providers; out-of-pocket costs for covered services; and how bills are paid.
Be sure to check on the physicians and hospitals that are included in the plan.
What is consumer-directed coverage?
Consumer-directed health plans allow individuals and families to have greater control over their health care, including when and how they access care, what types of care they receive, and how much they spend on health care services. The major types of consumer-directed coverage are:
Archer Medical Savings Accounts are individual accounts that may be set up by self-employed individuals and those who work for small businesses (less than 50 employees). To set up an Archer medical savings account, you must be covered by a high-deductible health plan. Either the employee or the employer may contribute to an Archer account, but both cannot contribute to the account in the same year. Individuals control the use of funds in Archer medical savings accounts and can withdraw funds for qualified medical expenses. You can roll over funds from year to year, and balances in Archer medical savings accounts are portable. This means you can take them with you when you change jobs or retire.