Understanding a Few Mysteries of Health Insurance Coverage

Everyone should have
individual health insurance. The benefits of having a policy outweigh the costs. However, it is not always clear how paying monthly premiums is a benefit, which is why you should talk to a licensed health insurance broker.



A Health Insurance Broker Breaks Down Health Insurance Conundrums

The health insurance marketplace is confusing. It is challenging for people without a broker’s license to understand the tier levels and overall differences between policies. Thankfully, several straightforward responses exist for many of the most common queries.

The Reason for an Enrollment Period

One of the most frustrating experiences when talking to a health insurance broker is the specific enrollment period. Many people believe that having a single enrollment period, lasting from November 1st to January 31st, is absurd.

Living in a free and capitalistic society, people want to buy what they want when they want it, but that doesn’t work for insurance companies or the government. The truth is a limited enrollment period is an essential part of the healthcare marketplace.

An annual enrollment period, open for only three months, helps insurers keep costs down; it also motivates people to purchase insurance as a preventative rather than a response to health crises. If people buy insurance only when needed, the behavior will increase costs for everyone else.

Talk to a health insurance broker if you are experiencing a life-changing event and need insurance. Some situations, like job loss, marriage, or pregnancy, may qualify you for special enrollment dates outside of open enrollment.

The Financial Benefit of Health Insurance

It should come as no surprise that healthcare costs in the U.S. are astronomical, even simple outpatient procedures cost thousands, and a hospital stay could land you in the poorhouse if you don’t have insurance. Still, health insurance is not cheap.

A healthy individual looking at an insurance price of $200 or more per month may find it difficult to justify the expense, especially if they are young and physically fit. You cannot look at health insurance as a current monthly expense; you need to consider it as potential future savings.

As any health insurance broker will tell you, policies are preventatives. You invest in insurance plans now so you aren’t caught off guard by medical expenses later. No one knows what the future holds.

While everyone hopes and prays for health and safety, accidents and illnesses happen. When you realize treatment and recovery for sickness and injuries can cost tens of thousands, if not more, it is relatively easy to justify the current investment in insurance.

You may also reduce your health insurance costs by investigating various state-run programs. For example, Covered California is a free service that can help eligible people save money on monthly insurance premiums.

Ultimately, it is a mistake to look at the investment into insurance premiums as a burden. The appropriate way to view insurance is as an investment in your future health and well-being.

The Reasons for Deductibles and Copays With Premiums

Any health insurance broker will explain that many insurance policies have three components: premiums, copayments, and deductibles. The premium represents your basic monthly costs to have coverage. A copayment is a set amount of money you must pay for doctor visits or treatments. Finally, the deductible is the amount you must pay before your full coverage kicks in.

While not all policies will include both deductibles and copays, many do. Policyholders often voice frustration with such
cost-sharing tactics, but they are necessary and permit insurance companies to offer the coverage they do.

You can often reduce your deductible or copay obligations by investing in a higher premium plan. Essentially, if you are willing to pay more per month, the insurer is willing to take on more risks. You will notice the differences in the marketplace between Bronze, Silver, Gold, and Platinum tier plans. While each plan offers the same benefits, the balance of costs changes between you and the insurer at each level.

A health insurance broker can help you understand the role of deductibles and copays. They can also help you select the insurance plan that best suits your financial and health needs.

The Anxiety of Pre-Existing Conditions

Before the Patient Protection and Affordable Care Act, insurance companies could deny policies for people with pre-existing conditions or charge them unfair premiums. The adoption of ACA protects individuals with pre-existing conditions, meaning no insurer can deny coverage.

Under the law, all Americans have access to quality and affordable healthcare coverage. While there are still some questions about the affordability of policies, eliminating discriminatory practices against people who genuinely need and could benefit from coverage is a step in the right direction for the American healthcare system.

A Health Insurance Broker Can Help

Are you ready to speak with a licensed health insurance broker about open enrollment or making changes to your existing policy? Contact
Sackett & Associates Insurance Services for more information.