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Myth 6 – You only get good health insurance through a large company

October 22, 2024 By Insurance Experts Leave a Comment

Corporate health insurance plans were expanded in the past as a means to not only draw in but also retain high-caliber employees. These plans often come with extended coverage, encompassing elements like additional doctor visits, laboratory tests, and imaging, accompanied by manageable co-pays. However, it’s worth acknowledging that these comprehensive benefits come at a considerable cost, even when considering the employer’s contribution. In today’s world, corporate health plans exhibit a trend towards providing reduced benefits coupled with higher deductibles. This landscape typically offers employees a range of plan options varying in deductible amounts, co-insurance rates, and allowances for doctor visits and urgent care, among other factors. Customization is primarily limited to these variables.

Moreover, when an employee departs from a corporate health plan, they are granted the choice to enroll in COBRA, which essentially maintains their access to the same health insurance plan but at the full cost borne by the employee. To illustrate, if the monthly employee premium previously stood at $300,  which the employer matched with $300, the employee’s COBRA premium would now be $600 per month. This signifies the plan while incurring twice the financial commitment. Additionally, it’s pertinent to note that often, associated life insurance benefits are lost as well.

In contrast, private health insurance plans extend a broader range of options to the insured, frequently at a more reasonable premium. In many cases, it proves advantageous for employees to forego COBRA and instead secure an independent private plan. Doing so can result in notable savings, often ranging between 30% to 50% of the employer’s COBRA plan costs. This approach offers a sensible and financially astute choice. And let’s not overlook the significance of maintaining your life insurance coverage in this decision-making process.

Filed Under: Open Enrollment Myths

California May Regulate and Restrict Pharmaceutical Brokers

October 17, 2024 By Insurance Experts Leave a Comment

“California Gov. Gavin Newsom will soon decide whether the most populous U.S. state will join 25 others in regulating the middlemen known as pharmacy benefit managers, or PBMs, whom many policymakers blame for the soaring cost of prescription drugs.

PBMs have been under fire for years for alleged profiteering and anticompetitive conduct, but efforts to regulate the industry at the federal level have stalled in Congress.”

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Filed Under: Health Insurance

Myth 5 – A good health insurance policy covers every medical expense

October 15, 2024 By Insurance Experts Leave a Comment

A sentiment frequently voiced is the desire for an all-encompassing health insurance that covers every possible scenario. While that concept is undoubtedly appealing, the truth is that the original intent of health insurance was to provide coverage for hospitalization and surgical procedures in the event of a major medical crisis. To put it into perspective, consider your automobile insurance – it doesn’t handle expenses like new tires, a transmission replacement, or filling up your gas tank.

In times gone by, as businesses aimed to attract and retain top-tier employees, health insurance plans underwent evolution, broadening their scope to go beyond catastrophic hospitalization and surgery. These revised plans featured perks like unlimited doctor visits with a modest co-pay, wellness care, maternity services, chiropractic care, infertility treatments, and sometimes even elective procedures classified as non-medically necessary, such as cosmetic surgeries like facelifts and breast augmentations.

With the escalating expenses associated with health insurance, there has been a shift within corporate plans to trim down coverage for many of these elective, non-medically necessary services. Here’s an example, a friend is employed by a large national corporation. Back when he and his partner were attempting to conceive their now 9 and 11-year-old children, they pursued In Vitro Fertilization, which incurred costs exceeding $30,000 per child. Remarkably, his company fully covered the entire expense along with the complete maternity costs. However, about a year after their youngest child was born, the company made the decision to discontinue that particular benefit, as the financial burden on the company became unsustainable. He regards himself as exceptionally fortunate for the coverage he received during that window.

Filed Under: Open Enrollment Myths

Effects of Health Insurance on Health

October 10, 2024 By Insurance Experts Leave a Comment

“This chapter presents the Committee’s review of studies that address the impact of health insurance on various health-related outcomes. It examines research on the relationship between health insurance (or lack of insurance), use of medical care and health outcomes for specific conditions and types of services, and with overall health status and mortality. There is a consistent, positive relationship between health insurance coverage and health-related outcomes across a body of studies that use a variety of data sources and different analytic approaches. The best evidence suggests that health insurance is associated with more appropriate use of health care services and better health outcomes for adults.”

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Filed Under: Health Insurance

Myth 4 – You can’t customize your health insurance to fit your needs or your budget

October 8, 2024 By Insurance Experts Leave a Comment

It’s essential to seek out a health insurance plan that can be tailored to align with both your specific needs and your financial considerations. For instance, one approach to maintaining a more affordable premium is to opt for a higher deductible. Conversely, you might prefer a plan with a zero deductible, granting you immediate access to the entirety of your insurance benefits.

Another consideration involves the inclusion of supplemental accident and critical illness coverage. These additional provisions can offer extra financial support in the event of an accident or critical illness, complementing your existing health insurance benefits.

These supplemental plans are designed to address out-of-pocket expenses and potentially replace lost income, particularly pertinent in the case of a critical illness.

An accident plan holds particular significance if your family members are actively engaged in physical activities, offering a safety net for unforeseen incidents. On the other hand, a critical illness plan proves especially valuable for those who are self-employed. In such a scenario, this coverage can provide vital financial relief by offering a lump sum benefit upon initial diagnosis which can be used to cover living expenses.

The inclusion of doctor visit coverage is another variable that can be tailored based on individual preferences, potentially influencing the monthly premium. Moreover, options to supplement your health insurance plan with dental and vision coverage can be chosen in accordance with your unique requirements.

Filed Under: Open Enrollment Myths

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