September 26, 2006 by bob.

Q. I am looking for health insurance. The plan I have now is no good and it costs too much. Can you help?

A. That isn’t much to go on . . .

When we talked I was a bit surprised to find out you did not know the name of the carrier, nor did you know the deductible or your out of pocket. All you knew is your office copay and monthly premium.

I shouldn’t be that surprised as your situation is not that different from many of the people I talk to. When asking details about their coverage, the typical answer is “I don’t know”.

I must conclude that the I don’t know plan is a popular one since so many have it.

The premium you are paying is about 30% too much. You have a lot of benefits you will probably never use. Your out of pocket is also out of line with the “norm” and is something you need to know in comparing plans.

The most simple method of comparing plans is to look at your annual premium + your out of pocket on a major claim. The plan with the lowest total at risk (premium + OOP) is the plan that you should choose.

Posted in Uncategorized | Print | No Comments »

September 24, 2006 by bob.

Q. I want a copay plan. I have always had one with my employer but now that I am looking for coverage on my own some agents are trying to talk me in to a plan that does not have copays. Won’t this cost me more when I go to the doctor?

A. The simple answer to your question is yes. It WILL cost more to go to the doctor under a plan that does not have a copay . . . but only IF you look at what you pay for services rendered.

Under most copay plans you will be responsible for anywhere from $10 - $50 for an office visit. Any balance is paid for by the carrier direct to the provider. The cost of this extra provider payment, as well as the administrative fees associated with adjudicating and paying a small claim are added to your premiums.

In your situattion the two plans most similar in benefits had premiums of $327/month and $464/ month. So you are paying $137 EXTRA each month to have a $40 copay.

If you did not have a copay your net cost (after repricing) for the doctor visit would be in the $60 - $70 range.

If you go to the doctor every month for the next 12 months the copay plan will cost you $137 + $40 every month for a total of $2124 per year.

If you do likewise under the no copay plan you will pay $840 per year for the cost of your office visits.

The difference in the two plans is $2124 - $840 = $1284 per year.

Which is a better “deal”?

Posted in Uncategorized | Print | No Comments »

September 19, 2006 by bob.

Q. I am losing my coverage with my employer and just need something to cover my son’s medication. The prescription runs $120 per month but we have only been paying $10 under our health plan. My husband also takes medication, but his prespription is very affordable. What is available?

A. You are not losing coverage, it is simply changing from a plan that is subsidized by your employer to one where you are expected to pay the full (true) cost of the health insurance. This is called COBRA.

If you are healthy, COBRA is very expensive. If you are not, it is a bargain.

We can cover you & your son for much less than you would be paying with COBRA and he will have full coverage for his pre-ex condition including the meds.

Your husband is another story . . .

His condition & meds, although inexpensive to treat, makes him uninsurable. I understand you can buy his medicine for very little, but the medicine is not the issue. There is a reason why carriers will not insure your husband. Because of what COULD happen while on the medicine, they are unable to assume the risk. If carriers don’t want to buy a potential large claim, that should set off warning bells that maybe you should look at othe options . . . such as COBRA for him while you & your son look at something less expensive.

Trying to pay $30 for meds is no big deal, even if he is out of work. Trying to pay off a $100,000 or more medical bill is tough even if he IS working.

Think about it.

Posted in Uncategorized | Print | No Comments »

September 15, 2006 by bob.

Just an update . . .

My clients who decided to buy health insurance from their auto insurance agent received an underwriting decision today.

The auto guy quoted a plan that was almost identical to the one I proposed. His final premium was over $100 per month more than my premium and the offer had 5 exclusionary riders.

My offer had 1 rider.

Case closed!

Posted in Uncategorized | Print | No Comments »

September 8, 2006 by bob.

Q. I have Spina Bifida Occulta but have managed it very well for the 51 years I have been on this earth. I have never been wheelchair bound, always ambulatory. I use lower leg braces during the day while working (truck driver) but take them off at night. I do not use a cane or any other assist. As I am moving to another state, I will be losing my group insurance coverage. An agent in the state I am moving to has found 2 carriers that are willing to write my coverage but will exclude Spina Bifida. Since I have never had any problems why are they excluding my condition? Should I try another agent?

A. Most carriers will automatically decline anyone who applies for individual health insurance and has Spina Bifida, so you should consider yourself fortunate there is any offer at all on the table.

By your own admission, the illness is not costly nor is it limiting in your ability to be mobile and function.

Full coverage will be available under a group plan, but most likely at a cost that is 3x what you will pay for the individual coverage.

I think you need to take the offer.

Posted in Uncategorized | Print | No Comments »

September 2, 2006 by bob.

Q. We have used the same agent for years for our homeowners & auto insurance. Because of the trusted relationship, we asked him to quote our health insurance. As it turns out, his company no longer writes health insurance direct but does allow him to write coverage through another company. We just got their offer and we are very disappointed. The rates came back $90/month more and there are many exclusion riders on the policy. Could we have done better?

A. You definitely could have done better.

Your P&C agent may know his stuff when it comes to auto & homeowners but he is in uncharted waters when it comes to health insurance. This should be evident by the offer.

Your medical history is quite extensive. I might be able to get you through underwriting with fewer riders, but I know I can save you almost $100 per month on premiums.

The carrier he used has rated your premium because of your weight. The carrier I would suggest will consider you a standard risk and will not load your premium.

I appreciate your loyalty, but is it worth paying an extra $1200 per year, every year just to have him service your health insurance?

Posted in Uncategorized | Print | No Comments »