Health Insurance

Health insurance is a policy that helps cover medical expenses by paying for doctor visits, hospital stays, prescription drugs, and other healthcare services. It reduces out-of-pocket costs by covering a portion of medical bills, depending on the plan’s coverage, deductibles, copayments, and out-of-pocket maximums. Health insurance can be provided by employers, government programs (such as Medicare or Medicaid), or purchased individually. It ensures financial protection against high medical costs and helps individuals access necessary healthcare services. Here at our agency we help you get coverage with a subsidy from the government. We can get you coverage with vision and dental as well.

Short-term health insurance is a temporary medical coverage option designed to provide limited health benefits for individuals experiencing gaps in coverage. These plans typically last a few months to a year (depending on state regulations) and help cover unexpected medical expenses, such as doctor visits, emergency care, and hospital stays. However, they often have high deductibles, limited benefits, and do not cover pre-existing conditions or essential health services like maternity care or mental health. Short-term plans are best suited for people between jobs, waiting for employer coverage, or needing temporary insurance but are not a replacement for comprehensive health insurance.

Find the Right Coverage:

We compare the rates between companies to find policies that best fit you. Here’s a list of our companies:

• Blue Cross Blue Shield
• Aneta
• United Health
• Pivot

How to understand your coverage

Monthly Premium: This is the fixed amount you pay each month to maintain your insurance coverage.

It does not go to your deductible.

Deductible :An annual deductible is the amount your health plan requires you to pay for healthcare each year before your health plan benefits kicks in.

Before you meet this amount, you are required to pay full price or the designated before deductible amount for health care.

Max OOP: An Out-of Pocket maximum is the most you’ll have to pay within a year for healthcare services.

Once you’ve reached your out-of-pocket maximum, your plan begins to pay 100 percent of the allowed amount for covered in-network, essential health benefits.

Costs that count towards your out-of-pocket maximum must include deductibles, coinsurance, copayments, or similar charges.

Co-pay: A fixed amount you pay for each medical service. Doctor’s Visit, Specialist, and prescriptions

Co-insurance: The percentage of the medical bill you're responsible for paying after your deductible has been met.

Example: Surgery and Insurance Coverage

Let's say you have health insurance with a $1,400 deductible, a 20% co-insurance rate, and a $7,550 out-of-pocket maximum. If you need surgery that costs $15,000:

Deductible: You'll first pay the $1,000 deductible out-of-pocket.

Which leaves 14,000 for the bill.

Co-insurance: After paying the deductible, your insurance will cover 80% of the remaining cost, which is $14,000. You'll pay the remaining 20%, which is $2,800.

That 1st surgery alone cost you 3,800 from being 15,000 in total which means the insurance company paid 11,200.

Out-of-Pocket Maximum: If you have other medical expenses during the year, they will also count towards your out-of-pocket maximum. Once you reach $5,000 in total out-of-pocket expenses, your insurance will cover 100% of all medical expenses for the rest of the year.

Then if you have other medical expenses like x-rays, bloodwork,etc. Since the deductible is met then you just pay a coinsurance rate which is the 50/50 percentage for that procedure. If the test costs 160, they pay 80 and you pay 80. So far in this term you have paid $3,880 and you keep adding until you hit your out of pocket max for that term which is $7,550.

Let's say you have health insurance with a higher coinsurance rate like 50% co-insurance rate, and a $7,550 out-of-pocket maximum. If you need surgery that costs $15,000:

Deductible: You'll first pay the $1,000 deductible out-of-pocket.

Which leaves 14,000 for the bill.

Co-insurance: After paying the deductible, your insurance will cover 50% of the remaining cost, which is $7,000. You'll pay the remaining 50%, which is $7000.

After you hit 7550 the insurance pays the rest. Which is broken up as insurance paid 7450 and you paid 7550 all together with deductible. Now all of the medical services after that are paid by the insurance company.

The Procedure:

When you visit the Doctor’s office, Pay for copays,prescriptions,lab tests,surgeries, hospital stays will go towards your deductible. So if you don’t go to the doctor’s office, probably only twice then get surgery. You owe that deductible if it costs more. Then the co-insurance will kick in with the percentage it is responsible for. 80% they pay then 20% you pay. After that, any other procedure will be handled with co-insurance until you meet your out of pocket maximum. Then the insurance will cover 100% of all medical expenses for the rest of the year.