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Individual Health Insurance Basics
Health insurance is changing rapidly in the United States and so are the choices. There are many variables that go into pricing and options one may choose. For example, preexisting conditions, gender, height and weight, medications, occupation, geographic location, and tobacco usage all play a role in value and price when choosing a major medical plan.
A person’s occupation such as the self-employed can influence a decision on ancillary products. These may include accident, critical illness, and life insurance. At Melliand Insurance we help tailor the options available based on your needs and preferences.
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Today, the majority of the insured with individual health insurance are enrolled in a managed care plan. A preferred managed organization (PPO) and a health savings account (HSA) are two forms of managed care plans. A PPO has arrangements with doctors, hospitals, and other care providers to accept lower fees for their services. These are called negotiated rates. As a result, your cost will be lower staying in network compared to out of network visits. These plans also have copayment options for a doctor visit. These can range from $10, $15, $25, $35, or no copayment. Remember, even with a no copayment option an insured would have a negotiated rate when visiting a doctor as long as they stay in network.
These plans do have deductible and coinsurance options with each plan. The higher the deductible the lower the monthly premium. At times, an insured can get more coverage with a higher deductible on their major medical and package ancillary products such as accident and critical illness to pay towards the deductible as well as sustain the business for a long term illness. This at times, can also provide better value.
Health Savings Accounts (HSAs) is the newest form of a managed care plan. Besides the flexible options of choosing your own deductible, copay, and coinsurance limits, a HSA allows a tax favored savings account to be used toward medical, dental, and vision needs. Again, with a managed plan, as long as a member stays in network they get negotiated rates. A good analogy would be buying a product at wholesale prices compared to retail. This could result in a 30-70% savings for a procedure done at the doctor’s office such as x-ray and lab work.