Navigating the Maze of Affordable Health Insurance

Co-pays, deductibles, max out of pocket, escalating premium, HMO, POS, PPO. What does all that mean to your family and your health insurance?

Unfortunately, in 2019, our choices for traditional health insurance plans and carriers have been drastically reduced once again. For those of us who are not covered by an employer or a spouse’s employer plan, we have three choices: Purchase a Kaiser, Ambetter or Anthem Blue Cross Blue Shield policy through the health care exchange, or you can choose a Kaiser or Anthem Blue Cross Blue Shield plan off the exchange. Both of which are all HMO plans.  Another option is to join a health care cost-sharing organization which have become very popular in the past few years.

A health sharing plan is a great alternative to the above. To begin with, Georgia Insurance Brokers recommends a plan that uses a national PPO network and therefore one can choose their doctors and they can be located almost anywhere in the country. If you have a college student or even a child that has graduated but is still under 26 years, they can be on this plan and use it in the city where they live. Another perk to the health sharing plan is they are considerably less expensive than traditional insurance plans.

As noted above, Kaiser, Ambetter and Anthem are all offering only their HMO plans. An HMO (health maintenance organization) is a closed system in which individuals and families voluntarily enroll to be treated by member physicians, and must get a referral to a specialists. One must stay in network and going out of the network will cost you significantly.

If you enroll in an HMO, you will most probably not be able to keep your current doctor. Even if you’ve been seeing your current provider for 20 years, an HMO will require you to use its physicians.

The physicians on these plans are excellent doctors, and some people may not be deterred by changing their current physicians. History shows that patients with chronic conditions (diabetes, respiratory ailments, arthritis, etc.) typically search for a compatible physician for years. They would rather pay higher premiums to stay with their current providers.

In the past, Ambetter has been an administrator for the Georgia Medicaid program, also called the Peach State Health Plan. Ambetter has not experienced an easy ride into the health care marketplace. A simple Google search yields harsh reviews, some of which are downright disturbing and all of which are convincing.

With all the traditional plans, the premiums are high, the deductibles are also very  high, and the max out of pocket is usually the same, very high. Most families don’t feel they are getting the appropriate value for their substantial premiums.

Many are still under the illusion that if you have the money, you can simply buy private health insurance. This is simply no longer the case, as no matter your income or ability to pay, you still have the same choices if you’re not covered by an employer (Kaiser, Ambetter, Anthem Blue Cross, or a health care sharing organization).

If you are self-employed or a small-business owner, you have the same three choices, but an alternative exists for you to create a Group Health Insurance plan. If you choose this route there are some rules that one needs to follow, for example, there has to be at least two employees who are unrelated, one of whom must be a W-2 employee working a minimum of 30 hours a week.  However, there is one insurance company that will allow a husband and wife to have a group plan for their business. This opens the door to several other companies to choose from.

Creating a group plan can be tedious, so make sure you work with a professional agent specializing in group health plans.

The health care cost-sharing comes with a few caveats so you need to be aware ahead of time. For example, you must be fairly healthy and not have a pre-existing condition. Although you can still be on this type of plan with a pre-existing condition and get treated, there is typically a wait for hospitalization. This is where your Atlanta Insurance Agent can help you and guide you in the right direction, answering all of your questions and concerns. One can also choose lower deductibles on these plans. However, remember a rule of thumb is that the lower the deductible, the higher the premium. Conversely, the higher the deductible, the lower the premium. Ga Health brokers always recommend a supplemental hospital plan for a nominal monthly premium for those who choose a high deductible. Not all health insurance plans and health care cost-sharing plans are created equal, so make sure you do your homework and work with an experienced health insurance agent from Georgia Health Brokers.