How Insurance Works

5 Things ALL Americans SHOULD KNOW about health insurance!


hey and welcome to this edition of
enlightenment with Bree! Today we’re going to go over the top 5 things that
all Americans should know about their health insurance… starting with what a
deductible is, defining a max out-of-pocket, different network types
and why it really matters, super easy ways to find all the
comprehensive plans that are available to you, and then lastly where are you
going to find the most value and the best pricing. So we’ll take a look at all
of those things in this edition! – let’s get started with what a deductible is. I get
this question a lot… but actually probably not enough… because a lot of
people are too scared to ask what a deductible is- so here’s what a
deductible is: it’s simply the amount you pay for covered health care services
before your insurance plan starts to pay. So let’s say you have a two thousand
dollar deductible and so you meet that two thousand dollar deductible because
you paid for all those medical expenses leading up to that two thousand… once you meet it though.. NOW the health insurance company is going to help with some of
the cost-sharing (that’s usually known as as coinsurance when you’re nearly 80/20
or 70/30) … but that’s all deductible is: if it’s a two thousand dollar
deductible, you just have to meet that amount before the insurance company
starts contributing anything. Let’s move on to our second topic, which is defining
a max out-of-pocket. Now I am EXTREMELY passionate about this because not a lot
of plans have them anymore and that’s why medical debt is at an all-time high
right now. But to start defining what a max out-of-pocket is: it’s just simply
the most you could be out-of-pocket in a policy or calendar year before the
insurance company starts picking up the expenses 100%. So
if you have a max out-of-pocket of let’s say seven thousand dollars but you, god
forbid, have an $800,000 bring surgery… okay, well, your max out-of-pocket or the
most you’re out-of-pocket is seven thousand dollars and the insurance company picks up the rest of the expenses. You have to be careful though because only
comprehensive and major medical plans have true max out of pockets. Typically a
short-term plan, limited benefits plan, an indemnity plan… they’re all going to set
limitations on how much they’re going to contribute towards your bill. This can be
a little scary because let’s say you get that eight hundred thousand dollar bill
and they say they only contribute four hundred thousand …well then you end up
owing four hundred thousand. Or let’s say that they’re very kind and they tell you
that they’ll contribute seven hundred and fifty thousand dollars towards your
$800,000 brain surgery… well you still owe $50,000. So you have to ask yourself
what types of bills are you most scared of…? because I know personally that I am
healthy I never really go to the doctor but I’m terrified and if I am
doing some yoga maybe and I end up tearing my ACL and going to the hospital and maybe needing surgery… next thing you know I have a fifty to sixty thousand
dollar bill and if I’m on a comprehensive medical plan then I know
that I have a set max out-of-pocket of seven thousand dollars. iIf I’m on a
limited benefits plan, indemnity, or maybe short term plan, it just depends on that
plan how much that they’re going to pay towards that but I don’t know what
that number is!! … it could be all of it or they make fun they might find a reason
not to cover me too because sometimes they have some shady loopholes in there
so you definitely want to ask yourself what are you most scared
of- it’s of course nice to have some benefits towards an annual physical/
towards sick visits…but it’s probably not going to break the bank though if you have to
pay those out-of-pocket even if you didn’t have a plan.
…but what WILL break most people’s pockets is just an accident, injury,
illness: food poisoning going to the hospital falling down the stairs
slipping and falling on ice etcetera Those are all very common things that
I’ve seen and those bills stack up!! If you’re like me and don’t have, you know,
fifty thousand or a hundred thousand dollars laying around in the bank.. or you
do and you just don’t want to put it towards medical expenses…. then definitely make sure your plan has a max out-of-pocket… Which again are
comprehensive and major medical plans. I hope that that makes sense you but if
you have any questions about it or you’re not sure if your plan has the max
out-of-pocket, feel free to just comment or leave me a message of what
carrier and network you have and in what state and I can let you know. The four different types of network and why it matters. So in ranking order from best
to worst.. PPO standing for preferred provider organization, HMO- health
maintenance organization. POS is point of service plan (it’s kind of a hybrid of a
PPO and HMO plan and then an EPO plans) its stands for exclusive provider
organization… but this is not the cool kind of exclusive like you get exclusive
access to a club or a party… no this exclusive means that you have very
limited options when it comes to finding a doctor that accepts this network. In
my opinion though, really an EPO plans and POS plans have similar rankings- it’s
just gonna be better one might be better than another for someone based on their
location and the carrier that they’re associated with but PPO by far is gonna
be the best because you’re gonna find the most doctors in network and they’re
gonna give you the highest reduced rate anytime that you go into a doctor’s
office visit you might receive a 50% PPO Reduced rate or a 40% PPO reduced rate for just being in network. Every doctor is a little bit different -they
all have different contracted rates- but PPO always has the highest and as we
move down on this list that percentage is lower which means that you’ll be more
out-of-pocket for those doctor’s visits or emergency room visits. So on to our
fourth topic: where does one find all the comprehensive medical plan options that
are available to you. It’s actually quite simple- there are only two avenues to go
down when looking for health insurance: one being the public marketplace which
is ACA Obamacare those names are interchangeable & mean the same thing and you can go directly to healthcare.gov. Do NOT go to health care dot com. *healthcare.gov*
and you can sign up for a plan there or I use healthsherpa daily- all day long
with my clients because it’s a much easier user interface and it definitely does
not generate billions of phone calls from agents but it’s just a lot more
user-friendly way to see what networks and options and pricing that are
available to you and I’ll leave a link below. The second option or second avenue that we can go down is going to be private health insurance- because
private plans ask more than just zip code and ages, you do have to go through
an agent like myself or another specifically licensed agent that’s
licensed to sell private health insurance like it’s not just any agent that you go
to -they have to be contracted with the private health insurance company. So
those are your two avenues to go down! All right last point here is where are
you going to find the best and value… is it going to be in the
private marketplace or public marketplace? -great question and I
actually don’t know the answer because it’s extremely dependent on your
situation your location what state you’re in a bunch of other factors. But, I
can tell you this: a public plan/ACA/ Obamacare plan- those a price based off
of income and a private health insurance plan is going to price based off of
health. So typically I find that public plans are the best fit for my clients
who have pretty significant pre-existing conditions maybe work in a
hazardous job or are considered lower income so they qualify for a subsidy
or reduced pricing through the government. These plans do price based off of your
gross adjusted annual household income so you’ll need to be able to predict how
much you’re gonna make this this year …that’s why it can be a little bit tricky
especially for people that are small businesses or owners and people that are
self-employed, contractors, freelancers, etc because typically we don’t know how much we’re gonna make that year…and if you end up making more than what you write
on the application, then at tax time the IRS is actually going to come back and hold
you accountable and responsible for the amount that you should have been paying, given your ACTUAL gross adjusted annual income. With private options, they don’t
actually consider income at all. These I find are typically better for those that
are self-employed, business owners, freelancers, contractors, just healthy
individuals and families, because you get really good pricing and benefits just
based on health. So while public plans cannot ask you any health related
questions, private ones can… so kind of like how life insurance works and if you’re healthy then you get put into a pool of
people and you’re either called “preferred” or “standard”… but it means that you pay less and get a better benefit because you’re either young or healthy.
-With private plans… if you can get into a “healthy preferred” plan, you’ll get better
benefits and save on monthly premiums Alright guys thanks for joining me on that
edition of enlightenment with Bree! I hope you found this very helpful. Show me some love and leave me a review or comment if this
was at all helpful for you. Be sure to subscribe and share with any of your
friends or family that are also looking for some good information on health
insurance and let me know if there are any topics you’d like me to go over in
the following weeks regarding health care and health insurance and I’m happy
to do that! Thanks and I’ll see you next time!


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