Health Insurance


Obama Care
-ACA Health Plans
   -On Exchange
   -Off Exchange
   -Health Savings Accounts(HSA)
-Medicare Supplement B Plans
-Medicare RX D Plans
-Medicare Advantage Plans


Did you know the average cost of a 3-day hospital stay is $30,000? Or that fixing a broken leg can cost up to $7500? Having health coverage can help protect you from high, unexpected costs like these.

How health insurance coverage works

When you have insurance, you pay some costs and your insurance plan pays some:

Premium- A premium is a fixed amount you pay to your insurance plan, usually every month. You pay this even if you don't use medical care that month.

Deductible- If you need medical care, a deductible is the amount you pay for care before the insurance company starts to pay its share. Once you meet your deductible, your insurance company begins to cover some costs of your care. Some plans have lower deductibles, like $750. Some have higher deductibles, like $5000. All plans provide preventive care services, and sometimes other care, before you've met your deductible.

Copayment- A copayment is a fixed amount you'll pay for a medical service after you've met your deductible. For example, after meeting your deductible you may pay $25 for a visit to the doctor's office that would cost $150 if you didn't have coverage. The health plan pays the rest.

Coinsurance- Coinsurance is similar to copayment, except it's a percentage of costs you pay once you have met your deductible. For instance, you may pay 20% of the cost of a $100 medical bill. So you would pay $20 and the health plan would pay the rest.

How insurance protects you

Insurance coverage protects you from high medical costs 2 ways:

Out-of-pocket maximum- This is the total amount you'll have to pay if you get sick. For example, if your plan has a $6000 out-of-pocket maximum, once you pay $6000 in deductibles, coinsurance, and copayments the plan will pay for any covered care above that amount for the rest of the year.

No yearly or lifetime limits- Health plans in the Marketplace can't put dollar limits on how much they will spend each year or over your lifetime to cover essential health benefits. After you've reached your out-of-pocket maximum, your insurance company must pay for all of your covered medical care with no limit.
People without health coverage are exposed to these costs. This can sometimes lead people without coverage into deep debt or even into bankruptcy.

ACA Health Plans (Obama Care)



The Patient Protection and Affordable Care Act (PPACA),commonly called the Affordable Care Act (ACA) or "Obamacare", is a United States federal statute signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act, it represents the most significant regulatory overhaul of the U.S. healthcare system since the passage of Medicare and Medicaid in 1965.

The ACA was enacted with the goals of increasing the quality and affordability of health insurance, lowering the uninsured rate by expanding public and private insurance coverage, and reducing the costs of healthcare for individuals and the government. It introduced a number of mechanisms-including mandates, subsidies, and insurance exchanges-meant to increase coverage and affordability. The law also requires insurance companies to cover all applicants within new minimum standards and offer the same rates regardless of pre-existing conditions or sex. Additional reforms aimed to reduce costs and improve healthcare outcomes by shifting the system towards quality over quantity through increased competition, regulation, and incentives to streamline the delivery of healthcare.

Two Ways to Purchase

-On Market/Exchange Plans
-Off Market/Exchange Plans

Medicare Supplement B Plans


provides medical insurance coverage for services such as physician' s services, outpatient services, and home health care. Participation under Part B is voluntary, and beneficiaries pay monthly premiums. Part B is also called Supplementary Medical Insurance.

Medicare RX D Plans


provides prescription drug coverage to patients eligible for Medicare benefits. This is a voluntary insurance program, not an automatic government benefit. This program provides some drug coverage, especially for those patients with economic hardships or those on high-cost medications. Patients are required to pay an extra premium (with their Medicare insurance) and are subject to a deductible before benefits are realized. Patients may be penalized if they elect not to join when they are healthy and are taking no or few medications.

Medicare Advantage Plans


A Medicare Advantage Plan basically replaces your use of Traditional Medicare. You still must pay your Medicare Part B premium that is automatically deducted from your Social Security check, that will not stop when you purchase the Medicare Advantage Plan. The following types of Medicare Advantage plans are available, but not always available depending on your county and state of residence:

Pros can be zero or very low cost to you per month, predictable co-pays like $10.00 or $15.00 for doctor's office visits, and lower cost hosptilization than Traditional Medicare, no deductibles, and most will include your Medicare Part D Prescription Plan.
Cons can be a restricted network of doctors that you must use, no maximum out of pocket limits, and some plans may resort to the old "referrals" to see a specialist.

Pros can be low cost to you per month, predictable co-pays like $15.00 or $20.00 for doctor's office visits, you can go in or out of network, no deductibles when you stay in network, no referrals for specialist, lower cost hosptilization than Traditional Medicare, an established maximum out of pocket, and most will include your Medicare Part D Prescription Plan.
Cons can be if you do go out of network you'll pay a deductible first before the cost is split by a percentage between you and the insurance company.

This is a "Private Fee For Services" Plan.
First the Cons: The single most important thing to remember about PFFS is the fact that you must contact the doctor or hospital FIRST to see if they take the plan. Even before you make an appointment to see a doctor, the doctor must tell you that they do indeed accept the terms and conditions of the plan.
The pros are similar to the PPO, it works basically the same. The monthly premiums are typically higher than the PPO, but less than adding a supplement.

Health Savings Account(HSA)


A health savings account (HSA) is a tax-advantaged medical savings account available to taxpayers in the United States who are enrolled in a high-deductible health plan (HDHP). The funds contributed to an account are not subject to federal income tax at the time of deposit. Unlike a flexible spending account (FSA), funds roll over and accumulate year to year if not spent. HSAs are owned by the individual, which differentiates them from company-owned Health Reimbursement Arrangements (HRA) that are an alternate tax-deductible source of funds paired with either HDHPs or standard health plans. HSA funds may currently be used to pay for qualified medical expenses at any time without federal tax liability or penalty. However, beginning in early 2011 OTC (over the counter) medications cannot be paid with HSA dollars without a doctor's prescription.[3] Withdrawals for non-medical expenses are treated very similarly to those in an individual retirement account (IRA) in that they may provide tax advantages if taken after retirement age, and they incur penalties if taken earlier.