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Frequently Asked Questions
There are many elements to consider when choosing an insurance carrier, including price, physician network and benefit design. Some carriers have smaller networks and than others. Some carriers may require referrals to see physician specialists. Your agent can help you sort through these items to choose the best insurance carrier for you.
You need to determine what benefits are important to you. Below we have listed some of the more important points to consider:
- The hospitals and physicians that are in the network of the plan you choose
- Doctor visit co-pay
- Prescription benefit and copay
- Annual deductible
- Out of pocket annual maximum
- Lifetime Maximum Coverage
- Health Savings Account Qualified Plans (tax advantage plans)
A deductible is a specific dollar amount that your health insurance company may require that you pay out-of-pocket each year before your health insurance plan begins to make payments for claims.
Coinsurance is the amount that you may be required to pay for covered medical services after you have satisfied any plan deductible. Coinsurance is typically expressed as a percentage of the allowable charge for a service rendered by a healthcare provider. For example, if your insurance company covers 80% of the allowable charge for a specific service, you may be required to cover the remaining 20% as coinsurance. Please note that definitions vary across insurance companies.
An annual maximum, or cap, is a defined dollar amount the carrier will pay toward your covered expenses within a calendar year. You will be responsible for covered healthcare expenses that exceed that amount.
Medicare is a federal health insurance program for people 65 years or older and for certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD). You are automatically enrolled in Medicare hospital insurance (Part A) when you apply for Social Security benefits – usually upon reaching 65 years of age. Part A covers inpatient care in a hospital or a skilled nursing facility, and hospice. Part A also covers services like lab tests, surgery, doctor visits and home health care. Part B covers physician and other health care providers’ services, outpatient care, durable medical equipment and some preventive services.
Medicare pays for many healthcare services and supplies, but it doesn’t cover all of your healthcare costs. For example, you pay a deductible for each hospital stay and coinsurance anytime you use the services of a physician or surgeon. Also, drug coverage is limited. Because Medicare rarely pays the full cost of covered services, you may want to consider a Medicare Advantage or Medicare Supplement insurance plan
A Medicare Advantage health plan, sometimes called Part C or MA Plan, is an alternative to Medicare Parts A and B. Medicare Advantage plans are offered by private companies approved by Medicare and provide all of your Medicare Part A and Part B coverage. These plans offer emergency and urgent care, limits on out-of-pocket expenses and some offer extra benefits such as dental, vision, hearing and/or health and wellness programs. Most MA plans offer prescription drug coverage. The most common types of Medicare Advantage plans include:
- Medicare Health Maintenance Organization plans (HMO
- Medicare Preferred Provider Organization plans (PPO)
Look at the “Is Entitled To” section of your red, white, and blue Medicare card. If you have Part A, “HOSPITAL (PART A)” is printed on your card. If you have Part B, “MEDICAL (PART B)” is printed on your card.
A Medicare Prescription Drug Plan (sometimes called PDP) adds drug coverage to Original Medicare and some Medicare Cost Plans, some Medicare Private Fee-for Service (PFFS) Plans, and Medicare Medical Account (MSA) Plans. Each Medicare Prescription Drug Plan has its own list of covered drugs (called a formulary). Many Medicare drug plans place drugs into different “tiers” on their formularies. Drugs in each tier have a different cost. Medicare prescription drug coverage provides protection for people who have very high drug costs or from unexpected prescription drug bills in the future.
A Medicare Supplement Insurance plan (Medigap) can help cover some of the costs that are left unpaid after Medicare Parts A and B pay their portion of your healthcare expenses. Unlike a Medicare Advantage plan, which is an alternative to your Medicare Part A and B benefits, a Medicare Supplement Insurance plan is purchased in addition to your Medicare Part A and B benefits.
Medicare Supplement policies are standardized into 10 plans – labeled “A” through “N”, each with its own set of benefits. All policies offer the same basic benefits but some offer additional benefits.
Medicare Supplement Insurance policies are sold by private insurance companies. While the costs of these policies may vary, individual insurance companies must provide the same standardized benefits. Some companies may offer additional benefits. To purchase a policy, in general you must be enrolled in Medicare Part A and Part B. In addition to paying the monthly Medicare Part B premium, you will have to pay a premium to the insurance company providing your Medicare Supplement coverage.
No. The so-called “employer mandate” only impacts companies with 50 FTEs (full time equivalents) or more. Note that this is 50 FTEs, not 50 employees. The law specifies the calculations for converting part-time employees to FTEs. Note also that companies under common control have their employee counts added together for the purposes of qualifying for the employer mandate.
Potential penalties are in effect for companies with more than 50 FTEs who don’t take certain actions with regards to their workforce. Penalties are assessed if an employer either does not offer health coverage to at least 95% of its full-time employees and their child dependents, if the plan is considered unaffordable, or if the plan does not meet a minimum value test
Yes. The tax incentive is available for employers with less than 25 FTEs, average annual wages less than $52,000 (adjusted each year for inflation), and who contribute at least 50% of the cost of the group health premium. For those companies who qualify, the tax credit is available for two consecutive taxable years.
The amount of the credit ranges from 3-50% of the employer contribution (to a max of 50% of premium) and varies according to average wages and number of employees. The maximum credit is available for those with 10 or fewer employees and average wages of $25,000 or less. The credit declines as either of those variables increase. Health insurance must be purchased through the government SHOP (Small Business Health Options Program) exchange in order to qualify for the credit
By working with a HealthMarkets agent, in many cases your employees will receive better health and financial protection with lower out-of-pocket expenses.
Group health insurance plans are categorized as either indemnity plans (also known as “traditional indemnity,” “fee-for-service,” or “FFS” plans) or managed care plans (PPOs, HMOs, and POS plans). The major difference between these categories are in regards to choice of providers, out-of-pocket expenses for covered services, and how bills are paid.
HealthMarkets has access to group health insurance plans from dozens of insurance companies nationwide. Our licensed insurance agents compare multiple options to find a solution that is right for each company’s specific needs.
Combined with health insurance, supplemental insurance (sometimes referred to as voluntary insurance) provides an added layer of financial protection for your employees to cover out-of-pocket expenses. Supplemental insurance can be especially helpful to fill the gap in high deductible health insurance plans since this combination provides lower premium costs while minimizing out-of-pocket expenses.
Employers looking for a way to cut costs while increasing employee satisfaction may find both by offering supplemental insurance as an optional benefit, according to a recent survey of small business owners.
Yes, your employees have the option of looking for health insurance through the individual marketplace. However, as long as you offer group health insurance that provides the minimum essential coverage and cost sharing in line with a Bronze plan on the marketplace, and has a minimum average cost sharing amount (actuarial value) of 60%, your employees will not be eligible for a government subsidy to help pay for their insurance. In some cases, the optimal solution for both the employer and employees is to switch from the group to the individual insurance market. HealthMarkets will perform an analysis to reveal your best option.
There’s no replacement for you and the contribution you make to your family. You want to make sure that people in your life, especially your dependents, can remain financially secure after you die. Bottom line: Life insurance financially protects your family and loved ones at a time when it is needed the most.
To easily determine your life insurance needs, use our Life Insurance Calculator.
Because the financial needs of your loved ones change over time, you should take a look at your life insurance policy periodically. HealthMarkets suggests you meet annually with your agent to review your current coverage and discuss any major life events such as change of income or assets, marriage, divorce, retirement, the birth or adoption of a child, or purchase of a major item such as a house or business. During that review you and your agent can determine if there needs to be a change to your life insurance coverage.
The standard term life policy covers death by any cause at any time in any place, except for death by suicide within the first two policy years (one year in some states), as long as your policy is in force.
Premiums for a term policy are guaranteed level for the duration of the initial term premium period, from 5 to 30 years in duration. After the initial premium period, premiums will increase annually for the duration of the coverage period.
Term life insurance has become very popular with consumers in recent years because premiums for new policyholders have dropped to all-time lows. Most companies allow you to pay on a monthly, quarterly, semi-annual or annual basis, so whether you’re a pay-all-at-once kind of person or you enjoy spreading it out each month, payment flexibility definitely makes term life insurance even easier to afford.
Most high quality term life policies sold today are guaranteed renewable, which gives you the right to continue your coverage beyond the initial rate guarantee period without a medical exam. This feature can become extremely important to your family should you become sick and uninsurable toward the end of your initial premium guarantee period. Also, look for a policy with a good conversion privilege and good, solid permanent policies to convert to.
Whole Life insurance is intended to remain in force during the Insured’s entire lifetime, provided premiums are paid as specified in the policy. Whole Life insurance offers three guarantees, a guaranteed premium, guaranteed cash value and a guaranteed death benefit. A whole life insurance policy builds cash value on a tax-deferred basis. This cash value may be accessed (using loans) for emergencies and opportunities, or to supplement retirement income.
Universal life insurance is an interest-sensitive product that combines cash accumulation and term insurance rates, providing great flexibility with premium payments. Decreasing the premium reduces the cash values available in the future and shortens the protection period or lengthens the premium-paying period. Increasing the premium increases the cash values or shortens the premium-paying period. Policy expenses and cost of insurance are deducted each month from the policy values; any unused premium is credited to the cash value account and is eligible to earn interest.
Premium payments for universal life insurance policies are flexible. If you miss a payment, the cash value of the policy is used to pay the monthly cost of insurance and administrative expenses. To maintain coverage, care needs to be taken to insure the cash value is not depleted below a level that covers the cost of insurance.
The cost of final expenses (burial, cremation, funeral service, casket) increases yearly. The proceeds from a Final Expense policy will help your family pay for these or other items. If you already have burial insurance, it might not cover the rising costs of your funeral. Final Expense benefits can also be used to pay for other expenses, such as medical bills, you may leave behind.
A final expense life insurance policy is a cash value permanent policy usually a whole life policy. The cash value builds within the policy which may give you financial flexibility in the future.
No. Beneficiaries can use the death benefit to pay for funeral costs, credit card debts, car payments, etc. This provides your loved ones with security and flexibility.
No. The premiums are guaranteed level. They will stay the same until the policy is paid up. Additionally, the death benefit will never decrease over the life of the policy.
Long Term Care Insurance
Long-term care is provided to people who are unable to perform the basic tasks of everyday living on their own for an extended period due to chronic medical, physical or cognitive conditions, or disabling injuries. Medicare, Medicare supplemental insurance (Medigap), and traditional health and disability insurance plans typically do not cover long-term care services. Long-Term Care Insurance covers long-term care services provided in a nursing home, at home, in an assisted living facility, or in other community-based settings.
This is an individual decision, based on many factors. Premiums are much lower for people in their 40s and 50s. After age 60, premiums for LTC insurance begin to rise steeply. An additional consideration is that as people age, they are more likely to develop health conditions that may make them uninsurable.
Medicare will only provide for some skilled care in very limited situations. Medicare generally covers acute care or skilled care such as that provided during a short hospital stay. Medicare typically does not provide coverage for assistance with the activities of daily living. Long-term care insurance is designed to cover activities of daily living.
Yes, but in very limited situations. Medicaid will generally apply only to those with very low incomes and very few assets. Even then, there is only limited choice of what and where benefits will be provided. For example, there might be limited choice of physician and facility, no control over the number of people sharing a room, or no ability for the family to pay for any extras.
Although medical insurance has some aspects of long-term care, they are not the same thing. For example, some medical plans may pay for the services of a nurse while you are recovering from an illness or an injury that requires medical attention. This medical benefit is very limited. Once you are better or reach the maximum benefit for nursing services, this benefit would cease to be available. Medical insurance is not designed to cover activities of daily living. Long-term care is designed to cover activities of daily living.
The benefits and amount of coverage an individual or couple needs depends on their unique circumstances. Your local insurance agent is the best resource to help you identify your needs and assist you with selecting a plan that best meets those needs.
Having an LTC insurance policy may not keep you out of a nursing home if that is the only place that can provide the appropriate care
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our office covers:
Individual & Family Health Insurance
Long Term Care Insurance
Small GROUP Health Insurance
Critical Illness Insurance
Final Expense Insurance
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