Why do I need to buy health insurance?

Health insurance offers you peace of mind. We work with doctors, hospitals and pharmacies to lower costs for our clients. So, just by having a health plan, you’ll usually pay less for care or prescriptions than if you didn’t have coverage—even before you meet your deductible.

When you sign up for a health plan, there are a lot of things to think about. Use the checklist below to help you get ready and then talk to us one-on-one. We can help you choose the best coverage, at the right price, for you or your family.

How much will it cost?

The cost depends on the plan you choose. Most health plans must cover a set of preventive services, like shots and screening tests, at no additional cost to you when you stay in network. The federal government offers financial assistance called “subsidies.” These tax credits lower your monthly payment based on your income, family size, location and the type of plan you choose.

What is included in a health plan?

All plans include:

• Doctor’s visits

• Hospital stays

• Outpatient care

• Prescription coverage

• Mental health care and more

HMO Versus PPO: Plan Comparison
Differences between HMO (Health Maintenance Organization) and PPO (Preferred Provider Organization) plans include network size, ability to see specialists, costs, and out-of-network coverage. Compared to PPOs, HMOs cost less. However, PPOs generally offer greater flexibility in seeing specialists, have larger networks than HMOs, and offer some out-of-network coverage.

Here are the comparison points in more detail.

Plan Networks
A defining feature of HMO and PPO plans is that they both have networks. Networks are one way to lower health care costs – network providers agree to give discounts in exchange for access to a health plan’s members. This saves health insurers money, but it also saves health plan members money as well – savings for the insurer can translate to lower premiums, deductibles and copays. In general, PPO networks tend to be broader, including more doctors and hospitals than HMO plans, giving you more choice. However, networks will differ from insurer to insurer, and plan to plan, so it’s best to research each plan’s network before you decide.

Primary Care Physicians
Most HMOs will require you to select a primary care physician, who will be the primary point of contact for your medical care. Your PCP will determine what treatments you need, and will refer you to specialists if he or she determines specialized care is medically necessary. Costs for specialists will not be covered without a PCP referral. In contrast, PPOs tend not to require selection of a PCP, and you can usually see a specialist without a referral, and still have these costs covered.

Coverage for Out-of-Network Care
For both PPO and HMO plans, your costs for care will be lowest if you receive it from in-network providers. The two types of plans differ considerably in coverage for services from providers outside the plan network. For HMOs, out-of-network services are usually not covered at all, except for emergencies. PPOs differ from HMOs in that PPO plans will usually provide some coverage for these types of services, but coverage for in-network providers will be much better.

Costs
The additional coverage and flexibility you get from a PPO means that PPO plans will generally cost more than HMO plans. When we think about health plan costs, we usually think about monthly premiums – HMO premiums will typically be lower than PPO premiums. Another cost to consider is a deductible. This is the amount of health care costs you must pay before your plan begins to cover your costs. Not all HMOs have deductibles, but when they do, they tend to be lower than PPO deductibles.

Gather some personal info about your household now, so you’ll have it handy when you’re ready to sign up:

• Your income tax information from the previous year

• The number of dependents you claim on your taxes

• Your zip code

• The birth dates for everyone who will be covered

• Social Security Numbers for everyone who will be covered

• Information about any health insurance provided by an employer

• Your email address

Find out if you can get help paying for your health plan.

If you are not offered health insurance through your job, you may qualify for government financial assistance to help you pay part of your monthly health plan bill. This is called a ‘subsidy’ or premium tax credit – the amount depends on things like:

• Your income

• Age

• Where you live

• The size of your family

We can help you find out if you qualify for a subsidy, and how much, and then enroll you in a Qualified Health Plan offered by Florida Blue.

Know your budget

We have a lot of health plans to choose from, so think about your budget and your needs.

Make a list of questions to ask us.

• Am I eligible to keep my current health plan?

• Can I still go to the same doctor and same hospital?

• How do I find a new doctor who is part of my health plan?

• How much will I pay when I go to my doctor or have a hospital visit?

• Do I need a referral from my primary care doctor to go to a specialist?

• What drugs are covered?

• How much will my medications cost?

• What are my pharmacy choices if I need a prescription?

• Are there any special services to help me if I have an ongoing health condition, like diabetes?

• What is the difference between my in-network and out-of-network benefits?

• What is a copay, deductible and coinsurance?

• Do I need any prior approvals for services or medications?

• How do I get dental coverage?

• What happens if I’m in an accident?

We can walk you through health plan options, the monthly cost of the plan and explain what medical services it covers. And make sure you get all of the financial assistance you deserve.