Health insurance is confusing, would you agree? In its simplest terms, health insurance plans are a means for consumers to have someone else pay for medical expenses. Clients pay a premium to an insurance company in hopes that they will pay for medical care when they need it. Premiums, deductibles, group health, marketplace insurance, co-pays, co-insurance, in-network, out-of-network, and health sharing plans are all available to protect your family and cover your health care needs. But which choice is right for you? Everyone has a unique health insurance situation. Sorting through all the confusing options can be stressful. An insurance brokerage company like MIB Health Insurance can help you navigate the confusing health insurance landscape and provide peace of mind along your health insurance journey.
We can all agree the billion-dollar health insurance industry is in dire need of reform. Mike Dietz, the owner of MIB health Insurance, believes that it is reminiscent of buying a used car in the 1970s. We thought the dealer was a friend and had nothing but our best interests in mind. That was not always the case. We buy cars differently nowadays, and so it is with health insurance. The healthcare industry has two sides. One is the healthcare system itself, where hospital systems, drug companies, hospitals, administrators, nurses, and doctors want to get paid top dollar for their services. On the other side is patient responsibility. If you want a way to beat the healthcare system, it is simple. Find the best way to not need medical care. Mike says, “Health insurance is like a tax on healthy people to cover the costs of unhealthy people. There is an element of accountability that must be assumed if health insurance reform is to take place. People have paid more for insurance and medical costs than ever before in history, and yet we are sicker as a nation. Common sense and taking responsibility for personal health is key to overcoming a broken healthcare system.”
That is where the power of choice comes in.
What are the Options?
It is important to take a realistic approach when choosing health insurance. Not all plans are right for all people, and there is more to health insurance than just health insurance.
Mike says, “Understanding a client’s needs and finding what fits them best within their risk tolerance is what we do. At the end of the day, it is about helping people get the coverage they need at a price point they can afford.”
There are options available to help you navigate the choices out there.
• Medicaid, Badger Care, and Forward are all health insurance programs for low-income individuals and families.
• What the insurance industry refers to as ‘the marketplace’ can offer premium tax credits to lower health insurance premiums.
• Direct plans are available with insurance companies but can be costly.
• There are short-term medical plans if you have no pre-existing health conditions.
• There are indemnity plans with pre-existing conditions with limited benefits
• Group Insurance may be available through your employer.
• Health Sharing plans can be a great option when traditional insurance is not available or cost prohibitive.
• Self-funded pharmaceutical plans can help save money.
The last three options, group health insurance, self-funded pharmaceuticals, and health-sharing plans, are worth defining further in this discussion about choice.
How Does Group Health Insurance Work?
Consumers think there are a lot of choices. Actually, most health insurance plans are about the same. Group health insurance plans are what most people think of when they think of health insurance. Group health insurance is offered as a benefit to employees. Many factors contribute to group health insurance, such as the size of the company, the earnings of individual employees, the health of the members, and the monthly cost to the employer and employee.
There are level-funded plans, self-funded and ACA community-rated plans, continuation plans such as Cobra plans, and retirement plans. An employer usually tries to find the best health insurance plan for the company and the employees who use it. Employers can also offer Health Reimbursement arrangements that incentivize employees to find their own insurance outside of the company in exchange for pre-tax compensation.
If your employer offers group health insurance, is it always best to take it? The answer is–maybe. You must look at all the options and sift through the details. That is where having an insurance brokerage firm that understands the options can be critical to saving time and money and helping you make the best-informed choice.
What is a Health Sharing Plan all about?
Health-sharing plans are a relatively new concept in health insurance. There are pros and cons of health-sharing plans compared with traditional health insurance.
There are many benefits to a Health Sharing Plan (HSP). They are usually best for healthy people who do not go to the doctor often for small health concerns. One benefit of a health-sharing plan is it is available to anyone without regard to income, employment, or tax status. Some Health Sharing Plans have no network restrictions, so you can use any doctor or medical system you prefer. Oftentimes they offer a lower monthly fee than traditional health insurance premiums. The rate is set, and you always know what you will pay month-to-month. HSPs have can have lower out-of-pocket costs for medical expenses, up to $1,000 per incident. Catastrophic medical care over $1000.00 is paid at 100% by the HSP.
Understanding possible downsides to a health-sharing plan can help you make an informed choice. HSPs do not offer upfront benefits like preventative care for no cost.
The patient pays discounted fees to medical providers directly, so there are no co-pays or deductibles. They do not offer coverage for maintenance prescription drugs. There are restrictions for pre-existing conditions. There is a time limit for each medical incident, and bills are only covered for 90 days after an incident has ended. The patient has the responsibility to negotiate cash discounts with the provider and must send detailed medical bills for reimbursement. An HSP does not cover medical issues like chiropractic care and mental health.
If you think a health Sharing Plan is right for you, MIB offers a program called MIB Plus to help with administering your HSP by working with medical providers to lower costs, submit medical bills, and access healthcare providers at a reasonable price.
Self-funded pharmaceutical programs
Using a self-funded pharmacy plan like RX Direct through MIB Plus can save a lot of money on pharmaceuticals. The benefit to a pharmacy direct program is that you can get cash discounts on prescriptions and are not limited to the number of times and amounts of drugs you can fill at any one time. Self-funded pharmaceutical programs give the maximum choices available to a patient who wants to take control of their pharmaceutical management. There is a wide range of prices for prescription drug plans (PDP). We suggest a prescription drug review to determine a plan that best fits your needs and budget.
MIB Health Insurance is a family-owned company with a team of caring health insurance professionals in the Fox Cities who want to understand your unique health insurance story. Together you can find the right health insurance solutions for you and your family. The Health Insurance experts at MIB are committed to providing peace of mind to help you understand your health insurance choices. Call a MIB Health Insurance expert at 920-731-2100 to see what the four steps to peace of mind may look like for you.