See insurance company links below to apply for medical, dental, vision and other individual products
How to pick a health insurance plan
three most important questions you need to ask Last updated: September 2014
Health care can be
very expensive. Having a baby costs about $30,000, and so does the average
three-day hospital stay. Health insurance is a way to reduce those costs to an
amount that you can manage by sharing the risk with others. That works because
most people are mostly healthy most of the time, so their premiums help pay for
the expenses of the small number who are sick or injured.
Here are the three major questions you
need to ask when picking a plan.
1. What does the plan cover?
Insurance sold to people and small
businesses must cover 10 “essential health benefits." Any plan you buy,
whether through your state's Health Insurance Marketplace or not,
will pay for these services.
Emergency services Hospitalization Laboratory tests Maternity and newborn care Mental health and substance-abuse
treatment Outpatient care (doctors and other
services you receive outside of a hospital)Pediatric services, including
dental and vision care.Prescription drugs Preventive services (such as
immunizations and mammograms) and management of chronic diseases such as
diabetes Rehabilitation services
The rules for insurance provided by
large employers are a little different but the vast majority them will cover
the same set of benefits. To make sure, ask your employer for the Summary of Benefits and Coverage,
a standard form that will state exactly what the plan covers and doesn't cover.
It's important to know, though that
some older plans may not cover this whole list of services. These are plans
sold to individuals or small business (with up to 100 employees) that started
before the new health reform law took full effect in 2014. Under certain
circumstances these plans can be renewed even though they don't have all the
consumer protections available with newer plans. If you have such a plan your
insurance company will send you a notice about it before the annual renewal
date. Then you can consider whether to keep it or to switch to a new
2. How much does the plan cost?You pay for health
insurance in two ways:
The monthly premium that you pay
to purchase your plan.The out-of-pocket expenses you pay
when you receive medical care. Those are some combination of deductibles,
coinsurance, and copays.
In general, if you pay a higher premium
upfront, you will pay less when you receive medical care, and vice versa.
If you purchase coverage through your state's Health Insurance Marketplace, you
may be eligible for income-based subsidies that lower the cost of your premium
and in some cases your out-of-pocket expenses.
To make comparison easier, plans sold
to individuals are grouped in standardized “metal tiers” with various
combinations of premiums and cost sharing: Bronze plans cover 60 percent of the
average member's total health care costs and thus have the lowest premiums
but the highest out-of-pocket costs. Individual deductibles for Bronze
plans in 2014 average $5,081, according to an analysis by HealthPocket, a
private health insurance data-crunching firm. Silver plans cover 70 percent and have
higher premiums and lower out-of-pocket costs than Bronze plans, with an
average individual deductible of $2,907. Gold plans cover 80 percent and have
higher premiums and lower out-of-pocket costs than Silver plans, with an
average individual deductible of $1,277. Platinum plans will cover 90 percent and
have the highest premiums and lowest out-of-pocket costs, with an average
individual deductible of $347.
Which of those plans
is right for you depends on your health and your financial situation:
If you already know you have an
expensive medical condition, consider a plan with a higher premium that
covers more of your costs.If you are generally healthy you
might come out ahead paying a lower premium and a bigger share of your
health costs, because those costs are most likely not going to be that
high. Of course, you need to be prepared to pay more if you do
unexpectedly become sick or injured.
The terms “cost sharing” or
“out-of-pocket costs” refer to the proportion of your medical bills you will be
responsible for paying when you actually receive health care. Cost sharing does
not include your monthly premium.
Unfortunately cost sharing is not
standardized from plan to plan and provisions can sometimes be complicated.
If you buy insurance through your state
marketplace, you’ll be able to see and compare the cost-sharing structure of
plans before you buy. If you get insurance through a job, the information will
be on the Summary of Benefits and Coverage
These are the four cost-sharing terms
you will see.
DEDUCTIBLE. The amount you pay every year before the insurance company
starts paying its share of the costs. If the deductible is $2,000, then you
would pay cash for the first $2,000 in health care you receive each year, after
which the insurance company would start paying its share. In every plan you can
buy, preventive services will be covered in full even if you haven’t used up
your deductible for the year.
Some plans will also pay a portion of your
costs for a few other services, usually doctor visits and prescription drugs,
even before your deductible has been met. This is more common with Gold and
Platinum plans but some Silver and Bronze plans also cover some services before
the deductible has been met. The only way to figure out whether a plan covers
some services "not subject to the deductible" is to study its
provisions very carefully.
COPAY. A fixed dollar amount you pay for certain types of care. You
might pay $30 for a doctor visit and the insurance company will pick up the
rest. Plans with higher premiums generally have lower copays, and vice versa.
And some plans do not have copays at all. They use other methods of cost
COINSURANCE. The percentage of the cost of your medical care that you
have to pay. For an MRI that costs $1,000, you might pay 20 percent ($200).
Your insurance company will pay the other 80 percent ($800). Plans with higher
premiums generally pick up a larger portion of the bill.
OUT-OF-POCKET LIMIT. The most cost-sharing you will ever have to pay in a year.
It is the total of your deductible, copays, and coinsurance (but does not
include your premiums). Once you hit this limit, the insurance company will
pick up 100 percent of your costs for the remainder of the year. Most people
never pay enough cost-sharing to hit the out-of-pocket limit but it can happen
if you require a lot of costly treatment. Plans with higher premiums generally
have lower out-of-pocket limits.
In 2014, the out-of-pocket limit for
plans sold to a person and to small groups cannot be more than $6,350 per
person or $12,700 for a family. But most Silver, Gold, and Platinum plans have
lower out-of-pocket limits than that. In 2015, the maximum out-of-pocket limits
allowed will increase slightly. They will be $6,450 for an individual and
$12,900 for a family.
3. Which doctors and hospitals are in it?
Every health insurance plan has a
network of providers—doctors, hospitals, laboratories, imaging centers, and
pharmacies that have signed contracts with the insurance company agreeing to
provide their services to plan members at a specific price.
If a doctor is not in your plan's
network, the insurance company may not cover the bill, or may require you to
pay a much higher share of the cost. So if you have doctors you want to
continue to see, you will want them to be in the plan's network.
Some state Health Insurance
Marketplaces, including those operated through the federal HealthCare.gov
site, have links to provider directories that you can see before you buy. But
the directories are not standardized and may be hard to use or out of date.
Moreover, to keep costs down, many of the plans sold through the state Health
Insurance Marketplaces have smaller networks than you may be used to. That is
why you should check and double-check with the health plan and your doctor's
billing office to make sure your desired providers are in the network of the
plan you are considering.
If you are given a choice of insurance
through a job, you can obtain provider lists from participating insurance
companies, or from the company’s employee benefits department. You can use our hospital Ratings (subscription required) to
research the quality of the hospitals in your network.
Please contact us with any questions
you have on choosing medical plans:
Aetna/Coventry Individual Medical Plans, Dental and Supplemental plans.
Blue Cross Blue Shield of Georgia Individual Medical Plans, Dental, Life and Short Term Medical Insurance
https://www.assurantemployeebenefits.com/wps/portal/ProductsAndServices/Dental/IndividualDentalPlans?pageLocation=/xhtml_clip/ourproducts/dental/individual/georgia_overview.html&agentid=4D00145-MG Generic Prescription Discount Plan
HSA BANK link to set up a Health Savings Account that can be paired with a High Deductible Health Plan. This site has a lot of education and research and guidance of how to use and set up these bank accounts to pay for your Qualified Medical Expenses
MY GEORGIA DOCTOR MEMBERSHIP SERVICE FOR COMPLETE MEDICAL CARE FOR THOSE THAT LIVE AND RESIDE AROUND THE ATLANTA, GA AREA. This plan provides affordable care for those who cannot afford expensive premiums monthly. YOUR FLAT FEE OUTPATIENT MEDICAL SERVICES PROVIDE YOU WITH:Annual Physical (age and gender specific) Unlimited primary care visits to any of our doctors at any of our clinics Discounted radiological and lab services Discounts on all specialists on staff - $150.00 for first visit and $75.00 for follow up visits
My Georgia Doctor is a revolution in the healthcare industry. My Georgia Doctor services are available to everyone regardless of sex, age, income, medical history or national origin, including non-immigrants & visitors.
My Georgia Doctor covered services include: Annual AMA Physical Exam Unlimited doctor office visits Blood Sugar Tests X-Ray and Lab Work EKG and Minor Surgery CBC, Chem Profile, PSA, Lipid, TSH, Etc. Minor emergencies Flu shots on availability Wellness and Sick Visits Discounted high-tech radiological services No medical underwriting and much more...
Local medical facilities are ready to serve you NOW!