At Prime Insurance Agency we have one goal in mind – to give you the proper coverage, with the best customer service, at the lowest available premium.
By choosing Prime Insurance Agency, you are choosing an independent insurance advisor who works for you, not the insurance company. We represent the most reputable and prominent companies in the industry, and these relationships translate into great insurance plans as well as direct savings for our customers.
With so many options of carriers available, we are able to focus on your and your loved one�s specific health insurance needs and deliver pricing options for your budget.
Unless you're a millionaire and can pay for your health care out of pocket, health insurance is a crucial purchase. The time to buy it is before you have an accident, suffer a serious illness or discover you're pregnant.
Individual health insurance doesn't cover health care for medical problems or conditions that start before the date you were issued a policy, although there are now Pre-existing Condition Insurance Plans available from the government. However, due to health care reform legislation, health insurers will no longer be able to deny coverage or refuse to renew coverage to adults with pre-existing conditions beginning on Jan. 1, 2014.
Your employer doesn�t have to provide health insurance
There are no state or federal laws requiring private employers to offer health benefits to their workers. However, many employers offer health insurance as a way to attract and keep workers. When group health plans are offered, they are then subject to a variety of state mandates about what benefits must be included, unless the employer is self-insured (meaning it pays the claims costs itself, not an insurance company).
Although health insurance mandates make coverage more broad, they can also pump up the cost. For example, the Council for Affordable Health Insurance (CAHI) estimates that adding coverage for contraceptives adds 1 to 3 percent to the cost of a group health plan. See CAHI's list of state-mandated health insurance benefits.
State mandated benefits do not apply to individual (private-market) plans that you'd buy on your own.
Whether you're buying individual or group health insurance, there are several health plan varieties, including traditional indemnity fee-for-service (FFS) plans, health maintenance organizations (HMOs), point of service (POS) plans and preferred provider organizations (PPOs).
Each plan has its own features to consider before making your choice. HMOs, PPOs and POS plans fall under the umbrella of "managed care" plans, which emphasize cost-effective medical care.
Fee for Service (FFS), also called indemnity
FFS coverage offers flexibility in exchange for higher out-of-pocket expenses, more paperwork and higher premiums.
FFS advantages
You may choose your own doctors and hospitals. There are no networks.
You may visit any specialist without getting permission from a primary care physician (PCP).
Most FFS plans have a cap, which is the most you will have to pay for medical bills in any one year. You reach your cap when all your out-of-pocket expenses (deductibles and co-insurance) total a certain amount. The insurance company then pays 100 percent for anything covered under your policy. The cap amount doesn't include your premium.
FFS disadvantages
There's typically a deductible (anywhere from $500 to $1,500) before the insurance company starts paying claims, and then doctors are reimbursed 80 percent of the bill while you pick up the remaining 20 percent. You portion is called co-insurance.
You might have to pay up-front for medical services and then submit the bills for reimbursement. To receive payment you have to fill out forms and send them to your insurer, or find a doctor who will do this for you. You also need to keep receipts for drugs and other medical costs.
FFS plans pay for "reasonable and customary" medical expenses. If your doctor charges more than the average for your area, you will have to pay the difference.
Not all health expenses you have count toward your deductible. Only services covered by the policy.
Health Maintenance Organizations (HMOs)
HMOs are often the least expensive in premiums but also the least flexible of all the health insurance plans. A major objective of an HMO is to reduce medical care expenses by increasing the use of preventive health services. HMOs are designed to maintain the individual’s health as well as provide adequate medical care when an illness or injury occurs.
HMO advantages
They offer low co-payments, minimal paperwork and coverage for many preventive-care and health-improvement programs.
Usually you have a wide selection of physicians and hospitals on HMO plans.
Participants pay a small fee (or a co-payment) of usually $15 to $20 for each visit to a physician in the HMO network.
Basic health services with an HMO typically include physician services, outpatient services, medical treatment, short-term mental health services and outpatient/inpatient emergency room visits.
HMO disadvantages
You must choose a primary care physician (PCP).
If your physician is not on the plan, you will have to obtain special permission and pay a higher proportion of the cost of the office visit or you will have to pay for the entire treatment from that physician.
HMOs require you to see network doctors, or you'll have to pay most of the bill or all of it.
The HMO directly and indirectly controls the amount of health care that the doctor is allowed to provide to you.
You must get a referral from your PCP to see a specialist.
If you require lab work and don't use a lab physician in the network, you will not be reimbursed for lab work.
If your regular physician drops out of the HMO plan, you must look for another physician that is in the plan, or pay a higher cost for using the same physician.
Point of Service (POS) plans
POS plans are more flexible than HMOs, but they also require you to select a primary care physician. A POS plan combines the care aspect of an HMO with the freedom of choice of traditional medical insurance. Sometimes HMOs will include a POS plan to be used for out-of-network benefits.
The POS plan arranges a network of health care providers who will treat plan participants for a small fee or co-payment, but at the time of an illness or injury, the patient may choose to visit a doctor outside the network. You then seek reimbursement from the POS plan.
POS advantages
Depending on your insurance company's rules, you may choose to visit a doctor outside the network and still receive coverage — but the amount covered will be substantially less than if you go to a physician within the plan's network.
POS plans tend to offer more preventive care and well-being services, such as workshops on smoking cessation and discounts to health clubs.
POS disadvantages
You must choose a PCP.
Preferred Provider Organizations (PPO) plans
PPOs give policyholders a financial incentive — reasonable co-payments (also called co-pays) — to stay within the group's network of practitioners.
PPO advantages
The standard co-payment is $10 to $20 for a routine office visit during regular hours.
You may go to any specialist without permission, as long as the doctor participates in the network.
PPO disadvantages
If you see an out-of-network doctor, you might have to pay the entire bill yourself and then submit it for reimbursement.
The PPO deductible is often the highest among small to midsize employers and rising. The median deductible for individual coverage for PPO plans was $1,200 in 2010, up from $1,096 in 2009 and $379 in 2000, according the National Survey of Employer-Sponsored Health Plans by Mercer, a human resources consulting firm.
You might have to pay a deductible if you choose to go outside the network, or pay the difference between what network doctors and out-of-network doctors charge.
PPO plans may charge you higher co-payments than what is specified on the plan if the physician charges more than what is considered “reasonable and customary.â€
How to find an individual health plan
Your first step in researching health coverage is look at coverage options and price quotes online or to contact an insurance agent in your area.
You should discuss with your agent your own particular health insurance needs. Think carefully about what coverage you must have. Is your doctor in the network? How much will you pay out of pocket for a routine check-up? How much could you pay out-of-pocket if you have a hospitalization? Are well-child visits included? Do you need prescription drug coverage? What about dental coverage too?
Making an informed decision when buying health insurance will prevent unnecessary problems down the road.
Seeking out a less expensive plan is obviously the fastest way to cut your insurance costs. But if you're not cautious, you might end up sacrificing some important benefits, says Dave Knowlton, president of the New Jersey Health Care Quality Institute. "You have to be certain that if the worst-case scenario happens -- you become seriously ill -- that you are adequately protected," he says.
Here are five ways to help lower your health insurance bill without lowering your standard of care:
Increase Your Out-of-Pocket Costs
A good thing to keep in mind is that insurance is supposed to protect against a catastrophe, not pay for regular health maintenance costs. The more you agree to pay for things out of pocket in the form of deductibles and co-payments, the less you'll fork over in premiums. "For young, healthy people, it's a good way to save," says Phil Lebherz, founder of the Foundation for Health Coverage Education, a nonprofit. You're not paying for doctors' visits you won't make, or services you won't use. A 25-year-old woman that increases her Oxford Health Plans deductible from $2,000 to $2,850, for example, could cut her monthly premiums by 18%.
Even better: Many high-deductible plans are paired with heath savings accounts, which allow you to stow away pretax contributions that grow tax-free and can be rolled over from year to year. Both employer and employee can add to the account. Until the deductible is met, any health-care expenses are paid out of the HSA. Keep health-care costs low, and it's possible to come out ahead, says Lebherz. But if you have significant health problems or expenses, the downside of this strategy can quickly outweigh any advantage.
Shop for Private Insurance
Buying private health insurance is the only coverage option for some consumers and the most frugal for others -- even if they have an employer-sponsored plan to choose from. A healthy, 30-year-old male in Texas, for example, could pay as little as $37 a month with a private policy, according to Insurance.com. That's $250 a year less than the national average employee pays for individual coverage. (On the other hand, someone with a pre-existing condition might pay upwards of $2,500 a year for private insurance -- five times the cost of the company plan.)
Shopping for inexpensive private insurance, however, requires a substantial commitment of both time and effort, says Jonathan Pletzke, author of "Getting a Good Deal on Your Health Insurance Without Getting Ripped Off." Every insurer gets to set its own requirements within the confines of state regulations, he explains. That makes for a complex web of options, many of which hinge on the results of a physical exam.
Also, check state-run programs that offer free or low-cost insurance. Women and children have better odds of obtaining coverage -- even if they aren't low-income, says Lebherz. A pregnant woman in California could make as much as $63,000 a year and still qualify for free health care through state insurer Medi-Cal.
Juggle Family Coverage
The days when a married couple could choose to have family coverage on both partners' plans is long over. Without the two-plan option, spouses need to take a close look at both of their plans to determine which offers the best coverage for the kids, says Pletzke.
Crunch the numbers to see if you'd be better off with everyone on one plan, or if you should split coverage. Shop around for private insurance, too -- especially if only one spouse is employed. It may be cheaper to keep one adult on the company plan, and buy a private family plan for the other partner and the children.
Reassess Employer Options
Nearly 60% of employers offer at least two plan options, according to benefits consultant Hewitt Associates. Even though one plan may have covered your health-care needs for years, it's important to reassess your needs each year. A decision to start a family or get some major dental work may make another plan a much more financially attractive option in the upcoming year. Here are two factors to consider while weighing your options.
Network providers: Health care is increasingly moving toward managed networks of physicians and facilities, says Knowlton. Check that you aren't unnecessarily paying a higher premium because your plan allows you a choice of physician. "If your doctor is already in network and your lab is already in network, do you really care about having more choice?" he asks.
Benefit range: The more benefits available to you, the more you'll pay. "Your premiums reflect as if you're using that benefit every single month," says Jeanne Brutman, a New York-based financial planner. If you're reasonably sure you won't need coverage for immunizations, maternity expenses or orthodontics in the coming year, switching to a plan that requires you to pay more out of pocket for such services (or doesn't cover them at all) could work in your favor.
Get Healthy
It may seem obvious that losing weight or quitting smoking will reduce the number of visits to the doctor, but it can also dramatically cut insurance costs. More than 70% of employers currently offer or plan to offer financial incentives to those who participate in company wellness initiatives this year, according to the National Business Group on Health. The reward? Cash or contributions put toward either a health-care account aimed at helping employees offset out-of-pocket costs or directly toward an employee's premiums.
Employees at Crown Equipment Corp. of New Breman, Ohio, for example, can cut their insurance premiums by up to $360 annually if they undergo a short health-risk appraisal and meet with a health coach at least once. Should their spouse participate, too, they'd get another $295. Dell's "Well at Dell" program is nearly as lucrative, but requires more commitment. Employees earn $78 each year for completing an online health assessment; and up to $225 more if they join and surpass one of the goals of a company wellness program. Family participation is encouraged, with another $303 in available incentives.
While some companies are rewarding good behavior, others are penalizing those who refuse to give up their bad habits. PepsiCo charges smokers $100 more annually for insurance coverage. And media company Tribune recently began tacking on a monthly premium surcharge of $100 for workers who use tobacco products.
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