Individual health insurance programs are designed for individuals and families who cannot obtain health insurance through an employer. Due to the continually rising cost of medical care, it has become more important to provide health insurance for you and your family.
TexasHIA offers health insurance programs to individuals with extensive coverage as well as high-deductible programs designed to protect against catastrophic losses.
As an independent agent, I can provide insurance plans from numerous health insurance companies. With the health insurance market constantly changing, I am always on the lookout for quality, service-oriented insurance companies for my clients.
I realize health insurance can be a confusing and daunting subject to tackle, so please do not hesitate to contact me with any questions.
Looking beyond the premium – what will your health care really cost?
When you’re choosing a health plan, it’s natural to look at the premium first – the amount you pay every month for the plan. But that’s just one piece of the cost puzzle.
The amount you pay out of pocket can be very different from one plan to the next. We’ll help you understand these costs ahead of time. That way you can choose the plan that’s best for you – and you won’t get an unpleasant surprise with your first doctor’s bill.
All plans have a Summary of Benefits and Coverage that clearly explains the plan’s out-of-pocket costs and the services the plan does not cover. Review it carefully. Here’s what to look for:
What’s the deductible?
Usually, you have to pay your bills out of your own pocket until you’ve reached the deductible. The deductible could be a few hundred dollars, or a few thousand. That’s a big difference. Plans with low premiums often have high deductibles.
Before you choose the plan with the lowest premium, take a look at the deductible. Will you be able to pay all your bills out of your pocket until you’ve spent that amount? If not, you might want to spend a little more each month on your premium, and get a lower deductible.
Important things to know about deductibles:
- Preventive care: You don’t have to pay out of pocket for preventive care received in-network, even if you haven’t met your deductible yet. Preventive care includes immunizations, screenings such as mammograms, and annual checkups.
- Stay in-network and save: Your plan may have two deductibles. It can have one for care you receive in the plan’s network, and a separate, higher one for care you get from doctors, hospitals or pharmacies that are not in the network. You can save a considerable amount of money if you stay in the network.
After you meet the deductible – then what?
So let’s say you’ve paid $2,000 out of your pocket, or $5,000, and you have met your deductible. Now the plan starts to pay part of your bills, and you pay the rest. Your plan might have copays – specific amounts you pay each time you see a doctor, go to an emergency room, or fill a prescription. And it most likely has a coinsurance. That means the plan pays a portion of the bill and you pay the rest. These amounts, for the most common medical events, are listed on the Summary of Benefits and Coverage.
Remember, stay in the plan’s network and you will save money.
You will continue to pay part of your bills until you meet your…
All plans have a limit on how much you pay out of pocket each year. (Your premium doesn’t count toward this maximum. Your deductible, copays and coinsurance do count.) After you meet the maximum, you don’t pay anything for services covered by your plan. Check for the out-of-pocket maximum in the plans you are interested in, since the amounts vary by plan. The government sets maximum amounts the plans can use, and they change every year.
For 2016, the most that a plan’s out-of-pocket costs can be are
- $6,850 for coverage for yourself only
- $13,700 for other coverage (you and your spouse, you and your family)
For 2017, the most that a plan’s out-of-pocket costs can be are:
- $7,150 for coverage for yourself only
- $14,300 for other coverage (you and your spouse, you and your family)
Medicare Supplements | Individual Health Insurance
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