Questions - Answers

Why health insurance is important

Health insurance provides financial protection in case you have a serious accident or illness. Your coverage can help protect you from high, unexpected costs and prevent bankruptcy. For instance, the average cost of a less severe heart attack is about $760,000.

Why is My Health Insurance So Expensive?

There could be several factors your health insurance is so expensive, including:

  • You have the wrong health insurance plan.

  • Your age

  • You are a smoker.

   Unhealthy lifestyle choices are linked to costly chronic conditions.

  • Healthcare in the U.S. is expensive

You don’t have to go much digging to find out that healthcare costs a lot in this country. Here’s an example. The New York Times recently reported that the U.S. spent more than $3.3 trillion on healthcare in 2016. That equals nearly $9,500 per American — or about twice what people in other industrialized countries spend.

It’s easy to blame these sky-high expenses on what hospitals or drug-makers charge. However, they’re just one part of the problem. According to a group of Harvard researchers, healthcare costs here are high across the board. “Drugs are more expensive [in the U.S.]. Doctors get paid more. Hospital services and diagnostic tests cost more. And a lot more money goes to planning, regulating, and managing medical services at the administrative level.”

Insurance companies account for all those staggering prices when they calculate health-plan costs.

In other words, you spend so much on health insurance coverage because your insurer spends even more on the care you receive from doctors and hospitals.

Why health insurance costs continue to rise

Here are some reasons:

1. Increasing medical costs

One of the main reason causes for the rise in health insurance costs are increasing medical costs. 

2. Medical providers are rewarded for doing more 

Most insurers -- including Medicare -- pay doctors, hospitals, and other medical providers under a fee-for-service system that reimburses for each test, procedure, or visit. This can incentivize the medical industry to order more services than are strictly needed. In addition to this medical system is not integrated, which leads to repetitive tests and over-treatment.

3. Rise of chronic illness and obesity

Did you know 6 in 10 adults in the U.S. population have a chronic condition, such as asthma, heart disease or diabetes? 4 in 6 have two or more chronic conditions. Chronic illnesses combined with an aging population drive up costs. Additionally, 42% of adults are obese, which leads to additional health conditions with estimated costs of $147-billion annually.

4. Healthcare is not consumer-centric

Another contributing factor to rising health insurance costs is that healthcare is not yet fully consume-centric. Most people do not pay directly for their health insurance—their employer does. As a result, many people don’t consider costs as they evaluate treatments and services.

5. Lack of cost transparency

There is no uniform or quick way to understand treatment options and the costs associated with them.

6. Pharmacy costs are skyrocketing

The final trend influencing the rising cost of health insurance is the skyrocketing costs of pharmaceuticals. 

7. Carrier consolidation

The six largest health insurance companies own the majority of the market. 

8. Fewer plan options and smaller provider networks

Health insurance companies know they have to control costs somehow to cover more people. While they do this fairly effectively given all the upward price pressures just discussed, this control comes at a cost to the consumer. Many carriers find themselves limiting the number of plans in their portfolios and the provider networks within each plan. Consumers in many markets are finding fewer plan options and have reduced access to doctors and providers.

How to choose the right health insurance for myself?

When selecting a health plan, I will ask you a lot of questions, so I can find for you the right product.

Those are some question will help you determine the right health plan for you:

  • How often do you see the doctor?

  • What types of healthcare will you need in the next year?

  • What prescription drugs do you take?

  • What hospitals and doctors do you want to see?

Is Health Insurance Mandatory?

  • Health insurance coverage is no longer mandatory at the federal level, as of January 1, 2019.

  • Some states still require you to have health insurance coverage to avoid a tax penalty.

  • Going without health insurance saves you money since you're not paying premiums, but it could put you at financial risk if you get injured or develop a serious illness.

What happens if u dont pay health insurance?

Your health insurance company could end your coverage if you fall behind on your monthly premiums. But before your insurance company can end your coverage, you have a short period of time to pay called a "grace period."

What is deductable?

The amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself.

After you pay your deductible, you usually pay only a copayment or coinsurance for covered services. Your insurance company pays the rest.

Generally, plans with lower monthly premiums have higher deductibles. Plans with higher monthly premiums usually have lower deductibles.

Types of network

1. Exclusive Provider Organization (EPO): A managed care plan where services are covered only if you use doctors, specialists, or hospitals in the plan’s network (except in an emergency).

2. Health Maintenance Organization (HMO): A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.

3. Point of Service (POS): A type of plan where you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. POS plans require you to get a referral from your primary care doctor in order to see a specialist.

4. Preferred Provider Organization (PPO): A type of health plan where you pay less if you use providers in the plan’s network. You can use doctors, hospitals, and providers outside of the network without a referral for an additional cost.