Affordable Health Insurance Plans - FAQ
General - Health Insurance Plans
About Affordable Health Insurance Plans
About Medicare Advantage Plans
Customer Service
Payment Questions
General - Health Insurance Plans
How do I get started?
From the homepage, begin the instant quote process in step 1. Choose the type of coverage that interests you, i.e., individual/family, dental or small business. Click the “Get Quote” button and follow the steps until your application is complete. It’s that easy.
What is health insurance?
Health insurance is a contract in which the insured and the insurer shares risk. The insured pays a premium to the insurer who pays a predetermined amount of money toward health care expenses.
What is the difference between a HMO and a PPO?
An HMO (health maintenance organization) and a PPO (preferred provider organization) are both managed care organizations that use certain procedures to manage the accessibility, cost and quality of healthcare. The levels of service and flexibility vary from plan to plan.
An HMO shares financial and delivery risks relating to health care services with those who are enrolled in a healthcare plan in exchange for a fixed, prepaid fee.
A PPO is a similar arrangement but the organization provides coverage for services through a preferred provider at a discounted rate. Services obtained by a provider who is not a preferred provider may be covered, but the rate may be substantially higher.
What is a deductible?
A deductible is an amount of money that an insured person pays out-of-pocket before the insurance company becomes responsible for any benefit payments.
What is the difference between co-insurance and a co-pay?
Co-insurance is the portion of costs that are shared between the insured and the insurer. It is common for an insurance company to pay 80% with the insured being responsible for the remaining 20%.
A co-pay is a predetermined amount of money that the insured pays out for certain services. For example, if you have a $20 co-pay on doctor’s visits, you would pay the doctor $20 for every visit and the insurance would pay the rest of the doctor’s fee for that visit. Special services, like x-rays or lab work, aren’t usually covered under the co-pay for the doctor’s visit.
Are co-payments counted as part of the annual deductible?
No, most insurance policies that have co-pays and deductibles handle doctor’s visits and hospital stays separately. You have to read the terms of your policy to be sure, but in most cases, a co-pay applies to the doctor’s visit and the deductible applies to hospitalization or other healthcare services.
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About Affordable Health Insurance Plans
What is the best health insurance plan for me?
Choosing between affordable health insurance plans is not as easy as it once was. Although there is no absolute "best" plan, there are some health insurance plans that will be better than others for you and your family's health needs. Plans differ in how much you have to pay and how easy it is to get the services you need. Although no plan will pay for all the costs associated with your medical care, some plans will cover more than others.
With any health insurance plan you will pay a basic premium, usually monthly, to buy the health insurance coverage. In addition, there are often other payments you must make. These payments will vary by plan but essentially are deductibles and co-payments.
Here's a list of key questions to consider in selecting the affordable health insurance plan that best meets your needs:
- How much will it cost me on a monthly basis?
- Are there deductibles I must pay before the insurance begins to help cover my costs?
- After I have met the deductible, which part of my costs is paid by the health insurance plan?
- What doctors, hospitals, and other medical providers are part of the plan?
- Are there enough of the kinds of doctors I want to see?
- Where will I go for care? Are these places near where I work or live?
- If I use doctors outside a plan's network, how much more will I pay to get care?
- Are there any limits to how much I must pay in case of major illness?
- What about limits and deductibles for certain types of care such as surgery or maternity?
How do I compare plans?
You can compare benefits and prices of different health insurance plans side by side using the "COMPARE BENEFITS" feature. On "Step 2: Compare Plan Benefits and Prices From Leading Companies", check the box of each plan you want to compare. Then click "COMPARE BENEFITS".
What types of health insurance plans are available to me?
Health insurance plans usually are described as either indemnity (fee-for-service) or managed care. Indemnity and managed care plans differ in their basic approach. Put broadly, the major differences concern choice of providers, out-of-pocket costs for covered services, and how bills are paid. Usually, indemnity plans offer more choice of doctors (including specialists, such as cardiologists and surgeons), hospitals, and other health care providers than managed care plans.
Indemnity plans pay their share of the costs of a service only after they receive a bill. Managed care plans have agreements with certain doctors, hospitals, and health care providers to give a range of services to plan members at reduced cost. In general, you will have less paperwork and lower out-of-pocket costs if you select a managed care-type plan and a broader choice of health care providers if you select an indemnity-type plan.
Besides indemnity plans, there are three basic types of managed care plans: PPOs, HMOs, and POS plans.
Where are the other health insurance plans I am familiar with?
Not all health plans sell health insurance directly to individuals and families. Some, such as Cigna, provide insurance predominately through employers.
What is a PPO?
A PPO is a Preferred Provider Organization. As a member of a PPO, you can use the doctors and hospitals within the PPO network or go outside of the network for care. You do not need a referral to see a specialist.
If you obtain care from a medical provider outside of the PPO network, you will pay more for the service. For example, a PPO might pay 90 percent of the cost for a visit with an in-network doctor but only 70 percent of the cost for a visit to a non-network doctor.
You will typically make a co-payment for each visit/service. These co-payments are typically higher than an HMO co-payment but not always.
You will usually be responsible for paying an annual deductible.
If you join a PPO, you should find you have more flexibility than with an HMO, but your total out-of-pocket costs are likely to be somewhat higher.
What is an HMO?
An HMO is a Health Maintenance Organization. As a member of an HMO, you select a primary care physician from a list of doctors in that HMO's network. Your primary care physician will be the first medical provider you call or see for a medical condition. He or she will make any needed referrals to a medical specialist. Typically, these specialists will be part of the HMO network.
If you obtain care without your primary care physician's referral or obtain care from a non-network member, you may be responsible for paying the entire bill (with exceptions for emergency care). With some HMOs, you pay nothing when you visit in-network doctors. With other HMOs there may be a small co-payment for the visit or service.
With most HMOs you will not be responsible for paying a deductible.
If you join an HMO, you should find that you have few out-of-pocket expenses for medical care—as long as you use doctors or hospitals that are part of the HMO.
What is an HSA?
An HSA is a Health Savings Account. It is a tax-advantaged personal savings account used in conjunction with a high deductible health policy. Individuals can contribute money to this account on a pre-tax basis to set aside money for qualified medical care and expenses, including annual deductibles and co-payments.
What is a POS?
POS stands for Point-of-Service, which is a type of managed care plan combining features of health maintenance organizations (HMOs) and preferred provider organizations (PPOs). You can decide whether to go to a network provider and pay a flat dollar amount or to an out-of-network provider and pay a deductible and/or a co-insurance charge.
What is an Indemnity Plan?
An indemnity plan is commonly known as a fee for service or traditional plan. If you select an indemnity plan you have the freedom to visit any medical provider. You do not need referrals or authorizations; however, some plans may require you to precertify for certain procedures.
Most indemnity plans require you to pay a deductible. After you have paid your deductible, indemnity policies typically pay a percentage of "usual and customary" charges for covered services; often the insurance company pays 80% and you pay 20%.
Most affordable health insurance plans have an annual out-of-pocket maximum and once you've reached this limit, they will pay 100% of all "usual, customary and reasonable" charges for covered services. Many health insurance companies have moved away from indemnity plans and are instead offering managed care plans such as HMOs and PPOs. You may have few or no indemnity plan choices in your area.
What is a provider?
A provider is a hospital, healthcare facility, physician or other medical professional that provides healthcare services.
What is a Primary Care Physician (PCP)?
A primary care physician is a medical practitioner or other medical professional who serves as a group member's first contact with a plan's healthcare system. Also known as a primary care provider, personal care physician, or personal care provider.
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About Medicare Advantage Plans
How do I apply for Medicare?
- If you already get social security benefits, you will be automatically enrolled for Medicare Part A and Part B effective the month you turn 65. In this case, you will be sent a card in the mail.
- If you are not receiving Social Security or Medicare, you can apply for both three (3) months before you turn 65. You can apply at your local Social Security Office.
- If you do not receive Social Security benefits, you must apply for Medicare, you should apply three (3) months before you turn 65 at your local Social Security office.
http://www.medicare.gov/Basics/Socialsecurity.asp
http://www.socialsecurity.gov/
What is the Medicare Advantage Plan?
Medicare Advantage plans are sold by private health insurance companies, these plans include HMO’s, PPO’s, private fee-for-service plans and Medicare special needs plans. These Medicare Advantage plans may cover more services than the Original Medicare Plan and you may get extra benefits and lower co-payments as well.
How do I qualify for a Medicare Advantage Plan?
You MUST have Medicare Part A and Part B in order to join a Medicare Advantage Plan.
How do I make payments?
The following is a listing of the Medicare premium, deductible, and coinsurance rates that will be in effect in 2007:
Medicare Premiums for 2007:
Part A: (Hospital Insurance) Premium
- Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment.
- The Part A premium is $226.00 for people having 30-39 quarters of Medicare-covered employment.
- The Part A premium is $410.00 per month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment.
Part B: (Medical Insurance) Premium
$93.50 per month*
Medicare Deductible and Coinsurance Amounts for 2006:
Part A: (pays for inpatient hospital, skilled nursing facility, and some home health care) For each benefit period Medicare pays all covered costs except the Medicare Part A deductible (2007 = $992) during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days.
For each benefit period you pay:
- A total of $992 for a hospital stay of 1-60 days.
- $248 per day for days 61-90 of a hospital stay.
- $496 per day for days 91-150 of a hospital stay (Lifetime Reserve Days).
- All costs for each day beyond 150 days
Skilled Nursing Facility Coinsurance
- $124.00 per day for days 21 through 100 each benefit period.
Part B: (covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment)
- $131.00 per year. (Note: You pay 20% of the Medicare-approved amount for services after you meet the $131.00 deductible.)
Additional information about the Medicare premiums, deductibles, and coinsurance rates for 2007 is available in the September 16, 2006 Fact Sheet titled, "Medicare Premiums and Deductibles for 2007" on the www.cms.gov website.
*Note: If your income is above $80,000 (single) or $160,000 (married couple), then your Medicare Part B premium may be higher than $93.50 per month. For additional details, see our FAQ titled: "Medicare Part B Monthly Premiums in 2007"
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Customer Service
If I have questions completing an application, how can I reach you?
You can reach our customer service representatives by phone at (800) 562-1043, Monday through Friday from 8:00 a.m. to 5:30 p.m. Pacific Time.
Questions about individual and family plans?
Call us Monday through Friday from 8:00 a.m. to 5:30 p.m. Pacific Time.
Questions about small business plans?
Call us Monday through Friday from 8:00 a.m. to 5:30 p.m. Pacific Time.
How can I be sure that my data is kept secure and private?
At HealthInsuranceStore.com, we are committed to protecting your privacy. HealthInsuranceStore.com will NOT SELL, TRADE or GIVE AWAY your personal information to anyone, except those specifically involved in the referral or processing of your health insurance quote or application.
Additionally, we use industry leading technologies to ensure the SECURITY of the information under our control. If you have any questions about our privacy statement, our company policies and procedures or your experience with our site, you can contact us at privacy@healthinsurancestore.com.
If I have questions completing an application, whom can I call?
Please call us at (800) 562-1043 for any assistance you may need and speak to our friendly and enthusiastic customer service representatives.
I noticed that you do not offer health insurance in my state. When will it be available in my state?
We are currently rolling out the service throughout the United States. Please send us your email address so we can notify you as soon as our service is available in your area.
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Payment Questions
What is a co-payment?
A co-payment is a fixed dollar amount or a percentage that you pay for each visit/service. For example, with some plans you may pay a fixed amount such as $5 or $10 per visit. Other plans will charge you a percentage of the total fee for the visit. So if your co-payment is 10% and the doctor visit was $200, you would pay 10% which, in this case, would be $20.
What is a deductible?
A deductible is the amount of annual medical expenses that a health insurance plan member must pay before the plan will begin to cover expenses. For example, if your health insurance plan has a $500 deductible, you will pay the first $500 of your medical expenses before your health plan begins paying the expenses.
Only expenses for covered services apply towards the deductible. For example, if you paid $100 for a visit to a chiropractor but the plan does not consider chiropractic care a covered expense, then the $100 will not apply toward your annual deductible.
What is the difference between an in-network and an out-of-network medical provider?
An in-network medical provider is within the approved network of providers for a particular health plan. Out-of-network providers are not on the list. If you visit a doctor within the network, your payment responsibility will be less than a visit to an out-of-network doctor.
In many cases, the insurance company will not pay for services you receive outside their network; however, there are exceptions to this rule. Generally, HMOs tend to have smaller provider networks than PPOs. In HMO and PPO plans, referrals to specialists will be to doctors within the network. Indemnity plans typically do not have networks; you go to whichever doctor you prefer.
What are my options for making my first payment?
Most health insurance plans require that a deposit accompany your application. You can pay this deposit to the health insurance company by credit card or check when you send in your printed application. If you are not approved for coverage by that health insurance provider, your money will be refunded.
Any financial information submitted over the web is kept private and secure. Once accepted as a plan member, all bills will be sent from the health insurance company and you will pay them via the choices offered by that company.
Do I pay more with Health Insurance Store?
No. Insurance companies charge the same premium whether the plan is purchased directly from the company, through a broker, or online through HealthInsuranceStore.com.
What do you mean by "best price"?
For the affordable health insurance plans presented here, we can provide the lowest price available anywhere.
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