Individual Health Insurance
We have health insurance plans for those who
- May qualify for a subsidy through the marketplace
- The Affordable Care Act brought a lot of changes in 2014. One of the most widely utilized changes is the government subsidy. Based on your family size, and household income, you may qualify for a federal tax credit. This credit applies to your monthly premium and is paid on your behalf, you’ll simply pay the difference between the total cost, and the credit.
- Are looking for catastrophic coverage
- There are great plans available for those who are healthy, can afford to pay for doctor visits, tests, etc., but want to have the financial protection from a major health event. These plans can be accompanied by a Health Savings Account for those looking for a reduction in their taxes.
It’s easy to be confused by Medicare, but you don’t have to be. There are different parts of Medicare and different coverage options. We can help analyze these options and help you determine which plan is best for you, your situation, and your budget. When scheduling an appointment, please bring the following information:
- A list of your medications
- How many you take a day
- Whether it’s the brand name, or a generic version
- How often you get them refilled
- The pharmacy you prefer to get your refills
- A list of doctors and facilities you prefer
- If you frequently visit another state, a list of doctors in that area
- A list of questions or concerns you will have for your plan
Medicare Advantage Plans
Medicare Advantage plans are also known as part C of Medicare. They replace your Original Medicare, which means Medicare isn’t paying any portion of your medical bills, only the plan you’re enrolled in is. These plans operate like a typical health insurance plan does: you have a list of providers you must see to be “in network;” you have copays, coinsurance, and sometimes deductibles; there is a maximum out pocket for your medical expenses; etc.
It’s very common to find plans that offer a $0 monthly premium, which is why these plans are attractive to some. Additional benefits are added to increase the desire for Medicare Advantage plans as well. Benefits such as dental, visions, hearing, and gym memberships like the Silver Sneakers program.
It’s important to understand that each Advantage plan is different, and each carrier is different. When talking to friends and family members that have already enrolled in Medicare, you’ll find many different opinions about Advantage plans. Apex Insurance has clients that have been on an Advantage plan for over 10 years and are extremely satisfied with their choice. We would love to discuss these plans and see if it’s the right fit for you.
How They Work
Advantage plans replace original Medicare. They are very similar to the style of insurance you may have had prior to turning 65. At that time, you had a list of providers that accepted your plan, some that didn’t, and you had a fee for services as they were rendered at a doctor’s office or facility. Medicare Advantage plans work the exact same way.
You’ll have a list of providers in network and that you are allowed to see. Seeing providers not in your network deems you out of network and your plan may or may not cover any portion of that visit. Each network size is different. In the area I am in while writing this, the plans I recommend have a nationwide network and provide coverage for out of network providers. Having to abide by a provider list alone can steer someone away from an Advantage plan. Being “limited” to a network is not always something one wants to deal with.
Another important aspect of an Advantage plan are the costs you experience as services are rendered. Again, this is set up very similar to your plan prior to turning 65. Your preventative care is covered at 100%, but you pay for other services as you need them. One plan for example, may only charge you $5 to visit your primary care physician. But to see a specialist, (meaning any doctor that isn’t a primary care physician), the plan might charge $75 per visit. A surgery may be 20% of the allowed amount, up to your out of pocket maximum of course, or it may only be $350 on another plan.
Advantage plans can be thought of as a “pay as you go” type plan. It may be a very low premium, such as $0 per month for a lot of plans in my area, but you pay for the services you need only as you need them. Medicare allows a maximum out of pocket, that’s the most YOU spend in one year for your medical bills, of no more than $6,700. If you’re looking for something with low monthly costs, an Advantage plan may be a good idea. This is also true if you do not anticipate to have any high medical bills in the near future.
Medicare Supplement Plans
Medicare Supplement plans are known as “Medigap” plans. The 20% that Original Medicare doesn’t cover, is picked up by a Medicare Supplement plan. There are quite a few to choose from and each of them have their own pros and cons. The plans that are most often enrolled in are plans F, and G.
When you enroll in a Supplement plan, you are keeping Original Medicare, and have elected for a separate insurer to make up the difference of your medical bills. When you go to receive treatment at a doctor’s office you’ll display both your Medicare ID card AND your Supplement ID card. The office bills Medicare first, then the Supplement Plan, and then you if you’re responsible for any portion. Some plans require you to pay the Part B deductible, so you may pay first, then Medicare, but this deductible is only required one time per year.
Group Health Insurance / Employee Benefits
If you are looking to retain your employees, offering group benefits is a very effective method. There are a number of different plans that we can combine to make up your benefits portfolio. Health insurance is where most employers start, but the following can be offered as well:
A relatively newer product that has hit the market is a partially self-funded health insurance plan. These plans give employers money back when there is a good claims year. They are typically more affordable than regular, fully insured, health insurance plans and can be offered with no network. The plan pays a percentage above wheat the Medicare allowed amount is. This allows your employees to visit any doctor of facility they wish without having to worry about networks.