Paying Too Much For Florida Health Insurance

I own insurance that will pay me if my house burns down. I have another plan that will protect me if I cannot work. Of course I have auto insurance in case my car is wrecked.

But, I can tell you without reservation, that I will not be unhappy if my house does not burn down, if I can go to work every day or if I avoid an automobile accident. I will not feel that I have been ripped off if I do not collect on any of these plans.

Yet, if you have health insurance and did not use it last year, you feel like it was money thrown out the window. At least that is what many of you tell me.

The intent of health insurance, or any insurance, is to provide financial relief in the event of a catastrophic situation. One where you will suffer financially if you had to pay out of your own pocket. This is how all insurance works. You do not get paid to replace a pane of glass in your home. Insurance with that type of deductible would be absurdly expensive. We never hear, "the hurricane completely missed my home, what a waste it was to have the insurance". Only a complete fool would make that statement.

Someone Should Be Paying My Medical Bills

I have never understood the entitlement attitude that many people have. Do you want to be sick so you get more out of your health insurance? Are you out of your mind?

We hear on an almost daily basis one of three constant, whining litanies.

The first is, “I had a plan where I worked and there was no deductible. It only cost $20 to go to the doctor and they covered everything.” Great, get your job back and have a nice day. I am sure any employer would be thrilled to have you and give you fantastic health insurance - for next to nothing.

The second is. “I am from (you fill in the country) and medical care was free.” Wonderful, we’ll miss you, we really will. I think there is a plane leaving in a few hours.

The third and equally annoying as the other two, is the individual who expects an insurance carrier to pay for medication and treatments for a prior illness. If you have not already learned the hard way, let me save you some time and trouble. Nobody, and I mean nobody, will cover your prior illnesses unless it is a guaranteed issue group health insurance plan. That is why group health insurance is so much more expensive than a private plan.

Superman Was a Make-believe Character

"I never get sick so I don't really need health insurance."
"I have not been to a doctor in 20 years and I am in perfect health."

Did you ever hear anything so idiotic? I swear, there are people out there who think that because they have never gotten really sick, that they do not need health insurance. I am not just talking about someone 20 years old who might not know any better.

Or, this idiot's twin which claims that they have never had their cholesterol checked, blood pressure taken, are over 50 and never had a PSA or PAP smear. Yet, they claim they are in perfect health.

I know people like this. I have visited them in the hospital while they tell me about the 20 year old surgeon who is learning to be a doctor by practicing on them. The uninsured make great learning cases in a teaching hospital.

What can I possibly say to someone living in their own fantasy world? At least get an inexpensive, high-deductible plan - just in case you are exposed to Kryptonite.

I Think You Are Ready

Now that we have a realty base where you know that:

- insurance is not free
- if you are very sick you cannot obtain it
- it generally will not cover prior illnesses
- the government is not going to paying for it any time soon
- you are not necessarily healthy because you do not feel sick
- if you can afford any health insurance at all, you need to obtain some

I will show you some ways to save money on your premium. I just did not want you to be somewhere out there in la-la land trying to find a plan that does not exist or denying that you do not need health insurance. I am sorry if anyone was offended. But, sometimes you just cannot mince words.

PPO Discounts

Let me explain just a bit about how a PPO works, how to take advantage of it and how you can save a lot of money on your health insurance. Remember, knowledge is power (although money is pretty good).

A Preferred Provider Option or PPO is essentially a contractual agreement between a provider of health services and the network. For every possible procedure or test that can be performed, there is a code. For every possible code, there is an agreed upon price. For instance, a well visit (checkup) might be $55 after the network discount. Or a lab test with a lipid panel might be $45 and so forth. Everything has its predetermined price. This price is generally a lot less than what the provider charges.

If you have a PPO plan AND your physician, lab or hospital is part of the network, you are entitled to the discounted rate. It does not matter if you have met your deductible or not. This is so important, I am going to say it another way. You get charged whatever the discounted rate the insurance company gets charged. You are in the "club". Do not pay charges at time of service. Make them submit the claim and wait for the insurance company to send you an Explanation of Benefits (EOB).

Deductibles

Remember that great group health insurance plan you once had with the $100 deductible and all office visits and prescriptions were $10? Remember when a slice of pizza was fifteen cents and the movies had double features? I am a little older so I do remember thoses days. But, those days are over.

The chances of you meeting your deductible is very slim. I am not saying it cannot happen. But, fortunately, the statistics are in your favor. Yet, many of you will spend $10,000 over the next seven years to lower your deductible by a few thousand dollars. Buy a calculator and do the math. Call me, I will do the math for you. I will show you what the "sweet spot" is for a deductible. It will save you a lot of money.

The logic of "We do not have a lot of money so a high deductible will break us if something happened", makes no sense (and this type of thinking is often one of the reasons you have no money). If you do not have a lot of money, how can you afford the extra thousands each year in premium for the low deductible? Let the hospital wait for the money. Pay them off each month if necessary. If you stay healthy, you win big.

What To Ask The Agent

One of the hard things about buying something that you do not know too much about is asking the right questions. I am going to help you.

On Physician Visits:

Mr. Agent, Sir, Your Lordship (hey I’m the insurance agent, why not), if a typical physician visit to a primary physician will cost somewhere between $55 and $65, how much extra am I paying for the privilege of having a $30 or $35 co-pay?

This is a very important question. The answer is that unlimited co-pays for office visits add about $50 to $75 a month to a plan. Now, those of you who are smarter than a fifth grader know that having this co-pay feature will save you about $30 a visit. But, unless you go to the doctor at least twice a month, each and every month, it just does not pay. So, if you are a hypochondriac, get the co-pay feature. Otherwise, skip it and use the power of the PPO network repricing.

On Deductibles:

O’ Wise and mighty Insurance Agent (I love this), I need a low deductible because if something bad happened to me, I could not afford to pay a high deductible. What deductible is best for me?

I am always floored when people tell me that. Do you know why you cannot afford to pay the high deductible? It is because you are spending all of your money on low deductible health insurance premiums. It is one thing to have the government take out too much from your paycheck. At least you get it back at the end of the year. But, to pay a $1,000 or more a year extra and make the insurance company rich (richer I mean) because you don’t have any money is insane. Or is it just me?

Look, here is how it works. You call for a quote. Let’s say it is a typical family of four in Polk County. The $1,000 deductible plan is about $686 for a loaded plan. Which, you should not buy anyway. The $5,000 deductible is $353 a month. Forget the calculator; it is a difference of almost $4,000 a year in premium.

Fortunately, the chance of you ever reaching your deductible is remote. Even with a $1,000 deductible you probably won’t ever hit it. But, let us say that after three years on the plan one member of the family has their gall bladder out and is hospitalized. They hit the deductible and by having done so, end up paying $4,000 more than someone with a $1,000 deductible. Big deal, you saved $12,000 over the three years. What if nothing happens for 10 years? You can figure that out for homework.

Now, one can only hope that the light has gone on. You buy higher deductibles, save the money (get an HSA plan) and have a weekend you’ll never forget with the difference. Or, do something crazy like paying off debt, saving for retirement or your children’s education. Between you and me, the poorer someone is, the lower the deductible they ask for. I understand their reasoning, but don't do it.

By the way, if you did owe the hospital money, they will accept payments, usually without interest. They are just glad you did not screw them and walk off on the bill.

On Prescriptions

Mr. Agent, I want a co-pay for prescriptions and the plan must cover all of my medication.

If you take a prescription medication a plan might or might not cover it. If it is expensive, the chances of them paying for it are slim to none. At the very least, they are going to raise your premiums enough to make them whole. Please, use your common sense. I am sorry you are in a situation where the drug manufacturers have you by the …whatever. But, chances are that you will somehow end up paying for your prescriptions for the rest of your life.

If you accept a deductible for brand name prescriptions you will once again, save considerable on your premiums. We do the math on this one for our clients as well.

Try to get generics, order from overseas, stay healthy. Also, explain to your physician that if it is at all possible, you want to try a generic. If they insist on a brand name, ask for samples. They have these huge cabinets filled with drug samples.

Next

Call me and ask for some fast, free quotes. I have numerous plans from a variety of different carriers. I will show you the difference in costs and let you make up your mind.

It is very important that you understand your coverage. It is not that complicated and I will explain it to you until you understand it.

800-272-0512 Mon - Thurs 9 AM to 9 PM and Fridays until 5 PM