Florida Health Insurance

Most of the time when we speak with someone who is coming from a group plan they want to duplicate the benefits they had while employed. They forget that an employer was footing at least half of the bill. Furthermore, the coverage offered by group plans often have deductibles and copays that you will not find with individual plans. So, before you start telling the agent what you used to have in New York, California or Texas and how you want the same plan, remember that in all probability you are wasting your breath. Focus on what is available now and what you can afford.

You cannot have too much health insurance but you could be paying a dollar to lower your deductible fifty cents. Don't get caught paying a "the fool's premium".

Health insurance companies will charge you a "fool's premium" for a very low deductible. A "fool's premium" means that to lower your deductible from say $1500 to $500, they will charge you an additional $1200 a year. So unless you manage to get admitted to a hospital in the first 10 months of your plan, you will always be the loser. Look carefully at the cost for different deductibles. How much does it cost for the next lowest and the next highest deductible? How many months will it take before you have lost the advantage of the lower deductible by paying the difference in premiums? Of course you could wind up in the hospital next month and call me up with an "I told you so". However, 99% of you or more will never reach their deductible.

If you have a business background you know about something called a "cost benefit". In other words, if I spend another $100 a month on health insurance, what extra benefits do I get? Are they worth it? Part of my job is to give you comparison quotes from different levels of coverage so you can decide if the benefit is worth the extra cost. I can't tell you how many people are paying a $1,000 a year or more extra to save fifty bucks on a doctor visit or prescription.

I like plans with high deductibles for prescription coverage. That way, you are protected in a catastrophic situation but handle the routine prescriptions on your own. Unless you have one hell of a lousy year, you will save money this way.

It was nice having all of those benefits in your group plan but now you are paying for them. Is it really necessary to have $10 doctor visits instead of $35 or even $50? How about if it costs you $500 a year for the privilege? If you go to the doctor twenty times it was a great deal. Otherwise, you have once again paid the "fool's premium". Listen friend, if you can't afford to pay $50 for a doctor visit then you are going to have a hell of a time paying for the health insurance. Don't be penny wise and pound foolish.

There are so many other places to put your insurance dollars.

WORD TO THE WISE: Use a medical supplement plan to bring your deductible down or eliminate it entirely. It is much cheaper than taking a lower deductible. We have low cost supplements that will reduce your hospital deductible and provide you with doctor visit coverage. Or, buy a high deductible and use the savings for disability insurance, dental insurance, cancer insurance or more life insurance. Hell, take a vacation before you get sick.

Before I continue, I need to make sure you understand a few simple terms and what they mean

a. Copay - this is usually for doctor visits and prescriptions. It is the amount you pay the doctor or the pharmacy. You DO NOT HAVE TO MEET YOUR DEDUCTIBLE FIRST. I cannot tell you how many times people tell me "I don't want a high deuctible, what if I have to go to the doctor"? One has nothing to do with the other.

b. Deductible - this is the amount you must first pay before the insurance company will pay for anything. Again, this does not include anything with a copay.

c. Coinsurance - after you meet the deductible you are still responsible for a certain amount of the bill. So, an 80/20 to $10,000 plan means that after you meet the deductible, you will be responsible for 20% of the next $10,000 which is $2,000. For some reason, right after I make this statement most people say "..so, I have to pay $10,000 after the deductible"? NO, (it has nothing to do with intelligence but most people suck at listening) you pay a percentage of the coinsurance amount not the whole thing.

d. Major Medical - this is not hospitalization only. It is the whole ball of wax, doctors, labs hospitals, inpatient, outpatient. Hospitalization plans, which are usually a waste of money and only a few dollars cheaper are hospital only.

Each insurance company in Florida arranges their rate charts to make certain deductibles more attractive than others. Depending on the company, this is generally between $2000 and $2500. If you move to a higher deductible the savings are negligible. If you try to move lower they might increase the premium by at least the difference or close to it. Remember, this deductible generally only comes into play if you have a serious illness and are hospitalized. I like slightly higher deductibles. However, you need to be comfortable with what you buy. (By the way, I make more money if you buy a lower deductible so I hope this makes you understand that I am giving you my honest opinion).

A doctor copay feature means that you will pay a fixed rate for an office visit when you are sick. The amount you pay is usually somewhere between $25 and $40. There is no deductible for this feature and it is available as soon as the plan becomes effective. Now for the fine print. This copay is for non-well visits only. It does not apply to physicals. It does not cover any testing or procedures performed outside the doctor's office.

Most people are very concerned with the how much they have to pay to go to the doctor. If you have 3 kids and they are getting sick every time you look at them, then a copay can come in handy. However, a PPO entitles you to the discounted rate for the visit. So, if you go to the doctor two or three times per year, you might save a hundred dollars. Don't pay too much extra for this benefit or be afraid to look at a plan without it.

WORD TO THE WISE: If you are in a PPO, the negotiated rate is usually around $50 - $60. Don't pay too much extra for a copay feature and make sure it covers specialists as well as general practitioners.

Once again, the fine print needs to be magnified. Each company deals with this benefit differently. I could never understand why plans were not more generous with well-visits.

When a plan brochure tells you that they cover physicals, mammograms, etc., they usually mean after the deductible. To which I say - thanks for nothing.

There are dollar limits to what the health insurance company will pay for well visits. Most often it is between $150 and $200. So, if you see a television show where they recommend you get a colonoscopy and/or an MRI every few years, remember that you will be paying for it yourself. Yes, I know it is a good idea to have all these tests done. The insurance company will agree with you. They just won't pay for them.

Florida health insurance laws have special provisions for children. They cannot charge a deductible for a child well visit. They can charge a co-pay and coinsurance. Nevertheless, this is much less than paying for it yourself. If you are dragging your kid to the doctor for checkups every few months (and they are not an infant). Or hauling them off to the doctor every time they sneeze, you need professional help. Look up the term Munchausen By Proxy on the Internet search engines..

Emergency room treatment is applied towards your deductible and coinsurance. If you purchase a supplemental accident rider, the first $500 of the an emergency room visit will be covered without any out-of-pocket expense. These riders usually cost between $6 and $8 a month per person extra. Is it worth it? Depends on your circumstances. If you ride dirt bikes, rock climb or have very active children, it might be. This rider will not cover the emergency room visit that you make due to illness.

We might be able to give you a standalone accident plan with better coverage for less money. If you feel that due to your lifestyle or sports that you or your children play you want to be more fully covered in the emergency room, it is not that expensive to do so. We have accident insurance plans that will pay $2000 to $5000 with no out-of-pocket on your part. Please ask about them. You don't even have to buy health insurance to have these plans.

The short answer to this question is probably not. At this point, I often hear - "Then what the hell do I need health insurance for". I was always told that there is no such thing as a stupid question. But, this one comes real close.

An insurance company is a for-profit entity and paying you for prescriptions that you are already taking would make them a not-for-profit entity. I can never understand why this is so difficult to understand. I can feel the daggers through the telephone when I deliver this bad news. Hey, don't shoot the messenger. If you want to go into a hospital without any insurance and become a science fair project for an intern that hasn't gone through puberty, that's your business.

A few Florida medical insurance plans will cover some medications you are already taking by kicking your premium up. Which, I do not consider a benefit at all. The sooner you stop complaining about the fact that you will have to pay for your own medication, the sooner your stomach will stop hurting and your blood pressure will go down.

WORD TO THE WISE: If you want a free Canadian prescription plan that will save you a lot of money, you can click on this link - Discount Prescription Plan. It is the application for an excellent program that will save you money on almost all of your prescription medication.

Yes, there are some plans that you can still get. They are not always as good as a major medical plan but far better than nothing. Go to Guraranteed Acceptance Health Plans. This site will describe some alternative plans.

You might qualify for a full major medical plan depending on the reason for your rejection. Florida does not have a guaranteed issue pool that will take anyone unable to obtain insurance. This is not the state to live in for extensive social service programs.

We routinely cover individuals who are rejected by Blue Cross/Blue Shield of Florida. They will reject you for conditions that many other companies will accept. Call us and we will advise you accordingly.

If you are a diabetic, cancer survivor of less than 10 years, or haven't been able to look down and see your feet since 1985, you will have difficulty getting coverage, if you can get coverage at all. High blood pressure and cholesterol are usually not a problem if controlled. Antidepressants are fine if you haven't been hospitalized. Most problems of this nature will not get you denied. Although, some companies are much tougher than others. I can usually tell you in advance if there will be a problem.

Now I don't want you to get upset (which translates to stop blaming me) but the fact is, your current medical conditions will in most instances not be covered. When faced with a preexisting condition, a Florida health insurance company will either; 1) Cover it with no exclusions, 2) Cover it but raise your premium a bit, 3) Insure you, but rider out the condition so that any treatment for the condition is not covered or 4) Deny coverage completely.

The most common question I hear is -"When will they cover my preexisting conditions and prescriptions?"
Answer : When we find Bin Laden.or When we pay teachers a living wage. Neither of which will happen in the forseeable future.

A good health insurance plan will cover the treatment associated with cancer. If you have a plan that doesn't cover cancer or requires an extra rider than the plan is plain crap. No two ways about it.

Now, on the other hand, there are often expenses associated with cancer that you will pay for that is not part of health insurance. Plus, if you have a limited plan or temporary health insurance or no insurance at all, you might want to have something extra. These plans are not expensive and will pay either a lump sum or a renewable sum each year. Stay away from this garbage that they sell you at work that will pay you a couple of hundred dollars a day if you have cancer and go to the hospital. Waste of money.

Sit down, we have to talk. A lot of you get real mad at me when I give you a quote an then chime in that the deductible is $2000 or $2500. I am a commissioned salesman. Don't you think I would love to sell you a plan with a $500 deductible? I clip coupons and look for two for one specials in the supermarket. I wear my son's hand-me-downs. Believe me, it is not my idea to walk around dressed like a gangsta rapper. But it is against my very nature to let you throw your money away. Give it to charity if its burning a hole in your pocket.

Let's say you had a huge deductible and coinsurance that amounted to $3500 out of pocket expense if you went into a hospital. However, you save $125 a month in premium over a plan that has a total out of pocket of $2000. Now watch carefully:
Year 1 - No hospital visits - you saved $1500 ($125 a month times 12)
Year 2 - No hospital visits - you saved $3000
Year 3 - No hospital visits - you saved $4500

It is unlikely that you will go to the hospital (statistically speaking). If you do, you can pay off the hospital bill. Why do
you want to pay for something that might never happen? This isn't taxes pal. There is no refund at the end of the year. It makes you feel better? Well in that case by all means do so, I can use the extra commission.

This is important. I mean real important. A PPO network has already negotiated a discounted rate with their providers. By belonging to the network, the providers have agreed to accept this rate schedule for their services. If you have a PPO plan and utilize one of these providers (doctor, labs, hospital) you are entitled to the discounted schedule rate. Don't take any crap from a provider who wants to charge you the full amount. I know managed care has been tough on the medical community but I am not ready to take up a collection. Somehow they still manage to drive a Mercedes and take ski vacations. Tell them to submit the bill and when the EOB (Explanation of Benefits) comes back, you will pay the re priced rate. If they are real hard asses, give me fifty dollars and tell them you will pay the difference or they can pay you.

I personally have a $5000 deductible and either have the doctor bill me so I can see the PPO rate on the bill when it comes back from the insurance company, or pay the PPO rate in the office. If you are going to have testing (colonoscopy, MRI, etc.) try to find out what the PPO rate is beforehand. You might be able to negotiate a fixed cash price that is lower.

Most Florida medical insurance plans do not have maternity coverage at all. For the one or two that do, here are the facts:
1. If you have had your previous child by C-section than you cannot get coverage until you have had another child by vaginal delivery.
2. You must take the maternity coverage when you buy the plan. You cannot add it later.
3. There is a 12 month waiting period before you can become pregnant.
4. Most plans do not even have maternity riders.
5. If you are already pregnant give me a call after the baby is born because you are not insurable, your husband is not insurable nor are any of your children. If you are interested in learning why, you can call me and I will explain it.
6. Go to the hospital and negotiate a fixed price for delivery. Everything is negotiable. Ask what the PPO rate is.

The rates used in this illustration come from an actual plan. The savings will vary with your age, number of family members, where you reside, etc. I am only trying to make a point with this illustration and I have many different plans where these numbers and benefits will naturally be different. I will quote a 40 year old male, 35 year old female and 2 children for a well rated PPO plan.

This is an illustration folks. Savings will vary according to what plans are available when you call.

Here is a very typical PPO plan:
- $25 doctor office visits (does not include lab fees, they go toward the deductible).
- Prescriptions have a $50 a year per person deductible then its $25 for generic and $35 for brand name.
- $1500 per person hospital deductible with a maximum out of pocket expense of $2500 on a hospital bill (80/20 plan so you pay the $1500 deductible plus 20% of the next $5000).

This plan will cost approximately:

$811 a month in Dade county
$595 a month in Palm Beach county and
$444 a month in one of Florida's less populated areas

Here is how the family used their insurance last year:

Kids each went to the doctor twice. That would have cost you $260 but you only spent $100. You saved $160.

You went to the doctor once and so did your wife. You saved another $80.

Your prescriptions were generic except for one and only two of you met the prescription deductible of $50 and then still had to pay $25 for each prescription. Total savings there was $100.

What did they pay and how much benefit did they get?

They paid anywhere from $5300 to $9700 in premiums for the year depending on where they lived. They got back $350 worth of benefit.

So they paid a lot and got back very little. What were the alternatives?

Now let's look at a different scenario. They buy a plan that will cover all of their expenses 100% after a deductible of $2500 per person (maximum 2 per year). They pay for the doctor, prescriptions, etc., out of their own pocket until the deductible is met. Well-care child visits are not subject to the deductible - according to the insurance company and Florida insurance law so they are free. Mammograms are also covered. The above individuals will pay approximately:

$437 a month in Broward county - Savings = $4400/year
$322 a month in Palm Beach county - Savings = $3300/year
$243 a month in one of Florida's less populated areas - Savings = $2400/ year

Remember, I use this illustration to make point. I have many different plans at different deductibles and premiums. I just want you to realize that you don't need to replicate your group insurance plan and make the insurance company and
their stockholders rich.

Once again I have to remind you that the kind of coverage you had when you worked for a large corporation is not available to you. Florida medical insurance plans for individuals and families do not have "real" dental coverage. If you have a group of three or more I can give you an inexpensive plan where you can go to any dentist you want.

We have a decent Dental HMO plan with free cleanings, x-rays, etc. Go to my dental plan page and look at the second plan on the page.

FLASH: I just got hold of a plan where you can use any dentist you want. At last, real dental insurance.