Listed below are Frequently Asked Questions regarding Health Insurance. If you have questions that are not addressed here, and would like to speak to a licensed health insurance professional, call Randall Richardson at 1-800-759-7587 or, in the Monroe area, at 318-372-5992.
Can I Pay Less for Health Insurance in Louisiana if I Deal Directly with an Insurance Company?
No. Health Insurance charges are strictly regulated by the state. Louisiana health insurance will cost the same whether you use an independent health insurance agent or communicate directly with an insurance company of your choice.
We represent a carefully selected group of respected, financially sound insurance companies, and we work to place your policy with the company offering the best health coverage to meet your personal needs, or the needs of your family or business. However, we don't work for any one insurance company - we work for you. Weıre on your side if you ever have a problem. We are committed to maintaining a high standard of excellence in all that we do and to establishing a firm relationship of mutual trust with each of our clients.
What Are Out-of-Pocket Expenses?
The short answer is the portion of the cost for medical goods, services and other care that the insured has the responsibility to pay. Insurance companies sometimes do not cover the complete cost of a medical expense. Depending on the policy benefits as defined in the terms, limits, and exclusions of your policy, certain parts of your medical bills could be considered the patient's responsibility. Some examples of out-of-pocket costs include:
Deductible: This is a predetermined amount of money that the insured pays before the insurance company will begin to consider reimbursing for covered medical expenses. For example, if you have a $500 plan deductible, the insurance company will not pay anything towards the cost of your bills until $500 worth of claims are reached. Only claims over $500 will be considered by the insurance company for payment.
Co-insurance: This is usually stated as percentage in your policy. It is the cost you are expected to share with the insurance company when charges are paid. For example, if you have already satisfied your plan's deductible, and the insurance company approves $1,000 worth of charges, the insurance company then pays a portion of them (say 80% or $800), and the balance (20% or $200 of co-insurance) will be the insured's responsibility to pay.
Co-payment: This is usually a fixed dollar amount that is attached to each specific type of medical expense and is expressly defined in the plan's benefits. For example, a visit to your primary care physician for a physical may cost you a $30 co-payment. The balance of the cost for this service is then paid by the insurance company.
How Are Premium Rates and Out-of-Pocket Costs Related?
With any individual health insurance policy, your premium is based on factors such as your age, where you live, and your health status. Another factor that has a substantial influence on the premium you pay is the level of plan benefits you select. When choosing a plan, it is important to understand that the lowest premium rate will have the highest out-of-pocket costs, and vice versa. These two factors work in opposite ways.
Depending on your budget, you may decide to make your out-of-pocket expenses as low as possible (by lowering your plan's deductible, co-insurance, and co-payments). This will increase the planıs premium cost. Conversely, you can lower your plan's premium by increasing your plan's deductible, co-insurance, and co-payments.
Can My Plan Include Preventative Care?
Preventative care coverage varies depending on the insurance carrier and the plan you select. Recent market trends have made this benefit more popular, and many times it is automatically included in the policy. Keeping the insured healthy has also become a goal of the insurance companies to help reduce their long-term costs. Some examples of preventative care benefits include routine physicals, mammograms, PAP and PSA tests, and child immunizations. Best of all, most plans will pay for these costs (up to a limited dollar amount) regardless of deductibles and co-insurance.
For example, if your health plan has a $1,500 annual deductible and the plan benefits are paid on an 80% / 20% basis, you might think all your preventative care would probably be paid out-of-pocket by you because they will get applied to your annual deductible. However, the insurance carrier usually sets aside the deductible and then pays 80% of the cost (up to a certain dollar amount). This substantially reduces your cost for preventative care and is the reason why many individuals with high deductible policies can benefit from this type of plan.
Why Does This Plan Cost More Than The One From My Last Job?
Many people are covered through employer-sponsored policies. These plans are highly regulated and include some very unique features that differentiate them from health insurance purchased directly by individuals. The most significant financial difference is that employers are mandated to pay a portion of the cost for their employees' health insurance premiums. Only a portion of the premium is paid by the employee through a payroll deduction.
When you purchase an Individual Health Insurance policy, you pay the entire premium cost; the expense is not shared with your employer. Studies have shown that employers, on average, pick up 75% (or more) of their employees' health insurance premiums. Although the full cost (both the employer and employee amounts) of your employer-sponsored plan may be more than the individual health insurance plan you have selected, it is really your employer's contribution toward the premiums that makes the health plan at your last job look so much more affordable.
Will This Plan Work Just Like The One From My Last Job?
When most people go to work at a company, they can usually choose between a few different employer-sponsored health insurance plans. These plans have been designed for this specific employer and the employee has little choice in altering the terms of the policy. When you apply for an individual health insurance policy, many of the benefit choices can be customized to fit your budget and lifestyle.
In addition to having the ability to modify your plan's benefits, employer-sponsored plans can sometimes have a lot more regulation that governs the benefit terms. For example, in most employer-sponsored plans, maternity coverage is mandatory. In most individual health insurance plans, this is an option that must be added to the benefits. To ensure you get the coverage you need, we will help to make sure you fully understand the benefit terms, limitations and exclusions of your individual health insurance plan.
Does The Advertised Premium Rate Always Match The Final Rate?
When shopping for an Individual Health Insurance plan, keep in mind that the quoted rates are an estimated amount based on your age and the geographic region in which you live. The final factor that is yet to be determined is the exact status of your health. Once your application has been completed, it is sent to the insurance company's underwriting department where they perform a careful assessment of your health.
Once the insurance company has estimated your specific health risks, they will place you into one of the underwriting categories: Approved - Preferred Rate, Approved - Standard Rate, Approved - Non-Standard Rate, or Application Denied. Therefore, depending on the health of the applicant, your final rate may be the same as quoted, higher than quoted, or possibly lower than quoted.
Can my health insurance premiums help me on my income tax return?
If you are self-employed you can deduct your health insurance premiums. However, if you work for a company who provides health insurance, you can't deduct the premium, or part of your premium, that your employer pays. You can, however, deduct the part of the premium that you contribute.
What is a Health Savings Account?
A Health Savings Account is like a regular savings account except that it allows you to save pre-tax income for health related purposes only. In order to qualify for a health savings account, you must already be covered under a high-deductible plan that will cover your medical costs if they are very expensive and you cannot pay them (ie. if you are involved in a traumatic accident and require a costly hospital stay. A high-deductible plan is used mainly for these types of catastrophic accidents as it does not cover the first few thousand dollars of medical expenses). A health savings account is beneficial as it allows the consumer to be in control of their own money and choose how to spend it, as opposed to letting the insurance company decide how to spend it.
If I don't have any health insurance, can I still set up a health savings account?
No, you must be covered under high-deductible insurance to be eligible for a health savings account.
If I don't have a job, can I still have a health savings account?
Yes, as long as you are covered under a high-deductible insurance policy you are allowed to start a health savings account, even if the money is not "income," per se. You can use personal savings or investment dividends to contribute to your health savings account instead.