Q: How can I find who has the cheapest rates?

A: The insurance companies set the rates. The best way to compare rates is through an Independent Insurance Broker/Agent, who can price several plans, based on your needs. There is no charge for this service, because the insurance carriers pay the broker/agent when there is a sale.

 

Q: Which health plan is right for me?

A: If you’re seeking comprehensive coverage that will pay for routine medical expenses, you want a comprehensive major medical plan. If you want to partner a tax-friendly health savings account with your major medical coverage, you want an HSA. If you’re willing to pay for smaller expenses, such as doctor office visits and prescription drugs, in exchange for protection against a large medical expense, you want a high deductible or "saver" plan.  If you are in transition or between jobs, you want a short-term plan.

 

Q: How can I estimate how much I'll spend on health care?

A: The federal government keeps records on the costs of health care for each zip code. Sublimo has a free software program, which will take your demographic information and health conditions, returning an estimate of your probable costs over the next year. While the program won't let you compare prescription drug plans of different health insurance carriers, you can get an idea of how one plan might compare with another. Go to Coverage Advisor.

 

Q: Why is Texas Individual Health Insurance so expensive?

A: With Group Plans, companies are required to pay at least 50% of an employee’s coverage.

 

Q: What is COBRA?

A: When a person leaves a company, the insurance company is required by law to allow the primary member to continue coverage for up to 18 months and secondary plan members to continue coverage for up to 36 months.  In Texas, these right is extended an additional 6 months.  That rate is what the employer paid, what the employee paid, plus up to 10%.

 

Q: How is Texas Individual Health Insurance different from other states?

A: Texas encourages health insurance carriers to offer well child preventive care, including inoculations up to the age of six years old

 

Q: What is Short-Term coverage?

A: This is interim coverage for folks that are in transition. It's a great choice if you're in between jobs or have just a few months left before qualifying for Medicare. However, while the plans are relatively cheap, they should not be your first choice, because if you get sick, you may not be able to renew or qualify for  major medical insurance.

 

Q: What is an HSA?

A: A Health Savings Account offers affordable health insurance, triple tax savings, and greater control over health care expenses.  For more information, see HSA Center.

 

Q: What are high deductible health plans?

A: These are health plans with high deductibles.

 

Q: What are "Saver" Plans?

A: These plans usually offer a limited number of doctor visits, with a copay.

 

Q: What is coinsurance?

A: This is the amount over the deductible that the insured is obligated to pay.  If the negotiated bill is $10,000, the Deductible is $2500, and the coinsurance is 20%, the insured pays a total of $4,000.

 

Q: What is the "total out of pocket maximum"?

A: This is the entire amount you would be obligated to pay.  That is the deductible, plus the coinsurance.  If it is a family plan, the plan may indicate a multiple, usually two or three persons, times the deductible.

 

Q: How long does it take to get approved?

A: The underwriting process takes four days to seven weeks, depending on the insurance carrier, the health condition, and the carrier's risk.

 

Q: What is an exclusion?

A: These are specific conditions or circumstances for which the policy will not provide benefits.