A premium is how much your plan will cost you on a monthly basis. The main two factors that affect your premium price are your location (zip code) and your age. Other factors may play a small part in determining your premium price like gender, tobacco use, or income.

An annual deductible is the amount your health plan requires you to pay for health care each year, before your health plan benefits kick in. Before you meet this amount, you are required to pay the full price amount for health care services.       

An out-of-pocket maximum is the most you'll have to pay within a year for health care services. Once you've reached your out-of-pocket maximum, your plan begins to pay 100 percent of the allowed amount for covered in-network, essential health benefits.

A copay is a set dollar amount that some plans require members to pay for certain covered medical services. Copays usually do not count toward your deductible, but this may be different for some plans. There are many private plans on the market that do not include copays.

Health Maintenance Organization  (HMO), Exclusive Provider Organization (EPO), and Preferred Provider Organization are the different networks or provider networks with your plan. Picking the right one for you and your family is critical as it changes access to medical care and may affect out-of-pocket costs. HMO’s and EPO’s are smaller more restricted networks that typically only give you coverage in your specific county or zip code. Most HMO’s and EPO plans also require referrals to see any kind of specialist. PPO plans will give you nationwide coverage, a bit more flexibility in selecting providers, and allow you to see a specialist without referrals.

Whether or not your doctor is in network will depend on which plan you choose. There are a couple of ways of finding out if your doctor is in network once selecting a plan:

i.      The easiest way to check is to book an appointment with me or contact me directly! Tell me the names of your preferred doctors and facilities and I will let you know if they are in network with your plan.

ii.      You can call the insurance company’s customer service phone number to find out if your providers are in the plan’s network. (Warning: be prepared to hold)

iii.      You can contact your provider and ask if they are in network with your chosen plan. Be sure to tell them the specific provider, network, and plan name. However, it’s always recommended to double check with your agent (that’s me!) or the insurance company.

iv.      (If continually on a plan) Most plans will have an online portal, where you can create an account and search the different doctors in your plans network.

The answer is… sometimes. It will depend on the plan and provider you decide to go with. Many public and private plans do also offer dental and/ or vision coverage to combine with and complement your medical coverage. If you need dental and/ or vision coverage independently of your medical coverage that is also available. Book an appointment with me and contact me directly to discuss your options.  

a.      On the public marketplace the open enrollment period is the first day you can enroll in, renew, or change health plans through the marketplace for the upcoming year. It starts on November 1st and ends on January 15th.  Outside of open enrollment you MUST HAVE a qualifying life event (QLE) to enroll on a marketplace plan, and coverage can only start at the 1st of the next month.

b.      Plans on the private market are not limited to the open enrollment period. You may enroll on a private plan during anytime of the year and coverage can start upon approval of the underwriting process.

There are several circumstances that may lead to an individual losing health coverage benefits from their family members.

i.      Happy Birthday! You’ve recently turned 26 (some states may have different age guidelines) and you are losing coverage from your parent’s plan

ii.      There’s been a change in the household such as a divorce or death

iii.      Your family may experience changes in your income that affect the coverage you qualify for

Health insurance is not a one size fits all product. Knowing which plan is best suited for you and your family’s needs can make all the difference between leaving you financial protected and exposed.

i.      You could ask your family and friends about their health insurance, but their situation may not be yours. You may qualify for something they don’t or vice versa, they might be paying extra for coverage that you don’t need.

ii.      You may be tempted to go online and fill out some information from an ad promising “free quotes” only to have your phone blown up by contracted agents and telemarketers trying to sell you something. Many of the ads promising “free quotes” will in fact not give you the quote you asked for but then go on to sell your information to lead generation systems, causing you to receive hundreds of calls and text messages about health coverage.

iii.      THE BEST WAY? Book an appointment with me or contact me directly. Here at Boudreau Insurance Solutions, I take the time to personally learn each of my clients’ situations and make sure I find them the best and most affordable health coverage plan suited to their needs. I respect my clients’ time working early mornings, late nights, weekends, and holidays, as well as their privacy keeping all client data safe, secure, and private.