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More Information
| · Self employed? · No coverage offered through work? · Coverage through employer too expensive / poor quality? · Spouse / children need coverage? |
 Joseph Jessome SmartHealthIns.com Health Insurance Specialist |
Folks, we need to know what we're buying!!!
Insurance COMPANIES not insurance AGENCIES determine the price(s)of their various products. Which means,the price per month for the product you purchase is the same no matter WHERE you find or WHOM you purchase it from. (I.E.) Internet,yellow pages,direct mail advertisement, an acquaintance, etc.Since your price is IDENTICAL, what should you look for from an agent? Two things to consider before you make a decision.
- Is the agent involved making an effort to show you why one companies
particular product would be your best value possible?
- Is the agency assuring product integrity and service AFTER THE SALE by offering professional references?
If another agent / agency offers you a different quote for an insurance product from one of our companies, then they are quoting you a DIFFERENT PRODUCT by that same company. Buying insurance on price alone is foolish and dangerous.
Health insurance should be purchased on the merit of value. That is, not a Price comparison between different companies, rather a Coverage / Price comparison between different companies.
This is the purpose of our spreadsheet. There are 5 points of consideration:
- Deductible
- Co – insurance
- Exclusions
- Limitations
- Price
Deductible
Most people are aware of their deductible. It is in the area of co - insurance, and especially exclusions and limitations, that clarification is often in order.
What we see in this spread sheet is a coverage / price comparison of four leading companies with the same deductible(s):
- As closely as possible, we are comparing the same product with five different cos.
- All these companies have been in business for 30 - 60 yrs.
- Some companies offer a deductible as small as $500.
On Job Coverage
Blue cross is the only company to not provide On Job Coverage (in FL). Sometimes people gravitate towards a particular good or service because of name recognition (marketing). The "$mart" consumer knows what it is they are buying. Simply put, don't buy a television commercial; buy the product that offers the most value for your health insurance dollar possible, and get the service you deserve, behind it.Doctor Visit
The total cost of a doctor visit is $60 - $140 (depending on the doc.). If you have a $25 co - pay, that means you pay $25 and the insurance company pays the rest. When you use a doc. visit co- pay, none of the cost of that visit is applied to your calendar year deductible. Let’s explore the options, of course, but many times, people find paying extra for “co – pays” is not worth it.Emergency Room Visit
With some companies, we can have the first $500 paid for by the insurance company in case of an accident. It will cost an additional $8 per month per person insured to do so. If a medical issue is more serious and the patient is taken from the E/R to the outpatient treatment area, then this situation is waived and we are looking at deductible / co - insurance.R/X (Prescription Medication)
This row on down covers the areas that make up the reasons why we need health insurance. That is, medical treatment(s) that could be very expensive. Generic medications shouldn't be a real concern because they are inexpensive . however, many times drugs are not available in generic form.
Brand name medication can be very expensive, this is why, in order to save themselves money (and make their products more cost competitive with other companies), some companies will only pay for a portion of these brand name drugs after the deductible is met.(Benefit max.Blue Cross 60% ) ... or perhaps only cover $500 max. per year. Remember you CANNOT add coverage, after the fact, in regards to a pre-existing condition/expense(s).
We have witnessed clients using thousands of dollars in brand name medication after they leave the hospital or doc.'s office to recuperate at home, sometimes for months, if not indefinitely. For this reason we feel it is important to have the medications paid for, by the insurance carrier, after the client satisfies their deductible/co-insurance.
Co-Insurance
Co-Insurance is what you owe after your calender year deductible. If you owe $0.00 after your deductible is met then you have a 100% co-insurance plan.
If you pay $3000 in co-insurance, then you have an 80/20 split on the next $15,000 of medical expense after your deductible. Example:
| $25,000 | (Gall Bladder Surgery) | |
| - 1,000 | (Deductible) | |
| $24,000 | (After Deductible) | |
| x 20% | (Of next $15,000 of medical expenses after deductible is met) | |
| = $3,000 | (Co-insurance) | |
| Total Owed by the Insured: $1,000 (deductible) + $3,000 (co-insurance) = $4,000 | ||
Possible Out Of Pocket Per Year
Using the example above, Possible Out Of Pocket Per Year would be $4000.Can you save money by purchasing your insurance on the internet?
Please understand, the web is used simply as another form of marketing for insurance companies or agencies. Again, we, as licensed agents, have no bearing on the price companies ask for their various products. No one can blame you for trying to "cut out the middleman" in order to save some of your hard earned money, but there is no markup involved by going through an agency vs. applying with a company directly.
What you do receive by going through a value based agency, is having someone with a vested interest in your satisfaction.
An agent is paid each mo. as you pay your premium. A good agent will be there to answer your questions, to review any and all paperwork with you in the event of a claim. In the event that billing information has not been submitted properly (we are dealing with human beings here, this can happen) you will want to be in control of the situation and know that you are not experiencing any unnecessary out of pocket costs.
Why be just another name in an insurance companies database, with no representation, especially when you will be paying the exact same price for your insurance? Also, it is good to have someone to work with you who knows the marketplace and who will continuously (year after year) be "on the lookout" for the best possible products and company for his / her respected client.
In a word, service. You will be paying for it anyway; why not receive it?
You have to be careful. Above and beyond your deductible, is there additional co - insurance liability?, are you covered on the job?, are there coverage limitations on or total exclusions in regards to expensive brand name medications or diagnostic testing? (Cat scan /M.R.I./upper - lower G.I.'s, etc.) Is there a good supply of “in-network medical providers in your area? What’s the best way to check this out?
These important points should be discussed with a knowledgeable independent agent, directly. The differences between companies and their products can be significant to enormous.
Finally, you have the Price Per Month for the product you purchase.
No one wants to spend more money per month than they have to, that's why it is crucial to recognize exactly what elements of possible medical expense we are trying to protect ourselves and or our family from, and to choose the product that covers those potential financial concerns in the most cost effective manner.
Give us a call/email and we will carefully review this info. together, completely.
"Hey Joe, why don't all agencies do business this way?"
Well, the reasons are as follows:
- INEXPERIENCE ... they don't know any better. No one, including ourselves,
knows what they are doing when they first become licensed. Unfortunately,
it seems everything has to be learned the hard way in this business
... hopefully not at your expense!
- MARKETING ... sometimes it is too much trouble/cost for certain agents
to go out and find their own new business. And, it is expensive to do so. These are known as 'captive
agents' who, in exchange for a weekly list of leads or contacts, agree
to write business for only one company .... greatly limiting 'YOUR'
options.
- COMMISSIONS ... everyone has bills to pay and in their haste to pay them, some agents will sell an insurance product just because it pays a commission up front. This advance commission is usually 8 months worth, paid immediately upon each sale, as compared to an as earned commission where the agent is paid each month as the policy holder pays his / her premium.
Without exception, the companies which offer the lowest amount of value to the consumer offer 'advanced commission' ... to entice sales people. Companies which offer products of value, pay 'as earned' commissions.
SmartHealthIns.com would rather wait to see its money.
Thanks,
Joe Jessome
SmartHealthIns.com Better Business Bureau member